What to do about burn out.

  1. My give a damn is broken....and it has been broken for a few years now. I have taken a less stressful job part time in Home Health...it has helped with this some. Unfortunately my husband is ill and has been out of work for a year now. So I have to have insurance and fortunately I am able to work part time and have insurance at my current job. Really, when I can be objective, this home health job is the absolute best job in nursing I have ever had. Comparing it with other positions, I am able to have more of a life.
    But something in me is just broke. I am not motivated to work hard, to do extra. I am always afraid I am one mistake away from loosing my license. Really this constant low level anxiety about making a big mistake has been constant since I became a nurse. I haven't made a big mistake, just tons of little ones....no more than most nurses, but that fear and anxiety hasn't improved even though I am a very competent nurse with lots of experience now (10years). I am sooooooooo exhausted from worry. I worry about phone calls from my manager even just for little critiques. I worry that I may have advised a patient wrong. I worry that I may have hurt one of my patients by missing something. I worry when at work and I worry on my days off.
    I have always had a hard time keeping up with changes, computer program changes, new forms to to fill out changes, added responsibilities changes. And I am tired of trying to stay on top of it.
    I was thinking about applying for a phlebotomy position at my facility. But I worry that taking any break from nursing will cause me to be unemployable or having to explain that I just had a period of burn out. I also fear not having enough money, but I would rather live in a tent under a bridge than keep trying to just plow through.
    I also really hate most of the advice out there for burn out. It's all like, "rest, take care of yourself, eat right, exercise, yadda, yadda, yadda". I am barely motivated to get out of bed on the days I work. Then I spent all my time off distracted about how few hours I have left before I have to go back to work.
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    About KalipsoRed21, BSN

    Joined: Jan '12; Posts: 80; Likes: 161

    14 Comments

  3. by   TristleRN
    Are you burned out? ... or could you be depressed? Not having motivation to do anything or not finding enjoyment in your regular activities sounds like depression to me. I'm certain that the stress you are under with having an ill husband only exacerbates things. In regards to all the other "typical" advice about taking care of yourself...well, you have to take care of yourself! Call your MD and discuss this...maybe you need just a little extra help.
  4. by   Libby1987
    I'm sorry for the anxiety and challenges you are facing and I'd like to speak directly to a few things related to your home health job.

    Home Health is unique in that we manage our compliance and reimbursement ourselves. This is not part of our training in nursing school nor are we exposed to it in any other field of nursing so it is very non intuitive. And the reality is, it is this way for everyone in home health which means all home health nurses have to go through receiving feedback no matter all that they've accomplished actually caring for their patients including navigating obstacles all day long. There's nothing like the feeling you get leaving everything on the field at the end of the day just to come back to corrections and/or what feels like criticism. It is just part of the deal having an unsupervised gig in an unsupervised industry, this is our due for being able to function mostly autonomously. It's frustrating but it is easier when you make peace with it and allow (force?) the feeling of "they're never happy" to roll off.

    Speaking to worry of making a mistake, build these habits as a safe guard..
    1) bring a check off list for everything that should be covered in a visit, you know what these are.. check for new/changed meds, med reconciliation, head to toe every visit as patient will allow, look back to last visit note for changes in condition, report change in condition, document reporting of change in condition, document patient able to give teach back on when to call or go to ED, document patient able to give teach back of your or agency's contact info.. you hardwire yourself to do those things every visit it'll become second nature, efficient and your bases are covered.

    As to losing your license? Go to work sober.
  5. by   Daisy4RN
    I am sorry for your difficult time! I agree with the other poster that you may want to be seen by your M.D. Sounds like the stress is just not getting better. I also have worked home health and agree that the work load is pretty much like above poster states. It might be less stressful for you right now to learn the ropes there (which would decrease your stress level). Nursing is hard work and can become draining where ever you work and sometimes you do just get to the point you are at now but you have to learn to have and keep perspective or it can eat at you. Do what you need to do to find balance and perspective, maybe counseling etc. I wish you well and hope your situation improves soon!!
  6. by   AnnieNP
    Please make an appointment with your Primary.
  7. by   SMSoulie
    I too say go see your Dr about possible depression and anxiety that can be treated. Nursing is so very hard and you have been doing it for 10 years without any big mistakes. You should feel great about that! Maybe it is time to investigate what jobs are out there that can offer less stress, use your experience, and you can see yourself excited about? Try looking at non nursing jobs at hospitals if you have large hospitals in your area. I just saw a few that wanted RNs but were not nursing. Also, Insurance case manager jobs? Or maybe something totally out of the box? Maybe there is something different that would provide earnings and insurance to meet your needs?
  8. by   KalipsoRed21
    Libby1987, I do thank you for your advice. It is good to know all home health agencies just throw you in, let you sink or swim, and try to coach you from the edge of the pool. However it is just ********. When people's safety and health, not to mention my sanity, are on the line I truly find no acceptable excuse for it. And I would say that about almost all the nursing experiences I've had with the exception of emergency room nursing. And honest to god, if the medical profession can come up with systems that evaluate nursing educational needs againsts tried and true algorithms to prevent slip throughs in every part of the patient's care (including insurance) in the most chaotic, fast pace part of Healthcare (emergency services) then there is really no excuse that should make it okay in other realms of Healthcare. You are not the first person who has tried to tell me how Home Health is "just this way". ********. It is "just this way" because no facility is allowing in their budget for an educator to come it and make an orientation plan that works. There are only 3 kinds of nursing to train in all of nursing 1) the ones who just started and don't know anything 2) the ones that a familiar with nursing but not the specialty 3) the ones who have practiced the specialty but need to know what the organization's expectations are. Their needs are different but very identifiable and really shouldn't be hard to come up with an acceptable orientation geared to each. Also, insurances are vastly different and confusing but almost all of those have basic guidelines based off of Medicare. So a general education about basic Medicare and or your State's basic Medicaid plans is really not unreasonable. Furthermore a class on Oasis that is provided by the home health employer should be a bare minimum that they are required to give the employees. A real education, not a 'complete your chart and I'll tell you why you screwed up this one'. Again I just feel that there are always a lot of excuses instead of action/resolution which always comes down to the budget. I believe the budget is super important...I worked for a hospital that went out of business and that was it's own kind of hell, but there are just some non negotiable things to have a good facility/organization,and staff and education are 2 of them.
  9. by   pro-student
    I understand how trite and cliche the advice about taking care of yourself can sound when you're in the midst of a very stressful situation without an end in sight but I would like to challenge you with this question, "If nothing about your situation changes, then why would you expect that your situation will change?"

    There is a probably a very limited extent to which things like working conditions, supervisor personality, and family issues are likely to change on their own so you have to look at the things you can change. Einstein said insanity was doing the same thing over and over again while expecting different results. I understand how truly difficult it can be to focus on self-care or a hobby when it feels like the world is falling down around you but something has to change for anything to change. Start small with something you can do consistently that you enjoy (preferably something that is not practical at all but purely for enjoyment). You don't have to change everything overnight but if you spend you days dreading work until you finally have to go to work, hating it while you're doing it, and they back to dreading it until your next shift, that's a recipe for disaster. I second all the recommendations to talk to a healthcare provider to consider whether there is something treatable you can do to make things easier but no medication is going to fix everything.

    Working in something like home care can be difficult because there's sometimes a perception that you're always on call or need to be available. I would urge you to consider what you true work obligations are and those "extras" like responding to phone calls or just stressing about things should be relegated to a confined amount of time. Maybe you have an hour a day when you will tend to work-related issues while you're not actually working but once that hour is up, leave it alone. You brain needs a break from work and, especially in the type of work you are doing, you need to carve out that time and stick to it. Some people might not like it but unless you are required to be on call (and should be compensated for that time) or you actually working, only you are ultimately in charge of how you spend you time. People will adjust and get over it and you will have a much better work -life balance.
  10. by   Leader25
    You are having several issues and the only comfort I can offer you is about that feeling of being "broken".I Would not bother with an MD appointment other than to get a full physical and perhaps something that will help with anxiety.Look for a counselor,could be shrink,or someone familiar with nursing,believe me it makes a difference.Your ability to cope is likely broken,or seriously strained.There are books,tapes,meditation they can guide you towards that will help you and your insurance should cover your counseling sessions.Keep it private.
  11. by   JKL33
    OP, although personal bents are affecting your situation like they do in every human being - I think some of your observations deserve validation, so here you go:

    The Change Train has run off the tracks. The constant critiquing is the element of this difficult job that is wreaking havoc and causing despair everywhere. Nursing has always been performed in less-than-ideal circumstances - sometimes very difficult ones - but working hard was never the problem. Working hard and being constantly criticized in nonsensical ways by people wielding crappy data despite people's excellent efforts is the problem. The subsequent blaming of nurses who begin to feel as you do, kalipso, is ethically wrong.

    **

    What will you do about it?

    I suggest re-focusing on self and loved ones - you know, those who are willing to participate in actual genuine relationships with you. I bet a good portion of your identity is tied up in being a nurse. I suggest beginning the difficult process of understanding that nursing doesn't mean to employers what it means to you. You need to change your thinking. This life is what you have, and it's time to start refusing to worry about things you can't change and people who don't care about you.

    Don't let your life be ruined over foolishness.

    Talk to your PCP and explain the ways that anxiety (too much worrying about foolishness) is crippling you.

    Things are gonna be okay.

    Best wishes ~
  12. by   Daisy4RN
    Quote from JKL33
    . This life is what you have, and it's time to start refusing to worry about things you can't change and people who don't care about you.

    ~
    This is great advice for everyone!!
  13. by   SarahLeeRN
    Caregiving is exhausting hard work. Everyone who is a nurse has the potential to burn out. Everyone has given good advice.

    I think if you have another non-nursing job option you should do it. And just keep per-diem status for the sake of the resume. Why limit yourself with phlebotomy? That might not be far enough away from healthcare to help you get some motivation back. Maybe there is a coffee shop that could use a new employee!? Or anything really...there are many options out there in life. Just have to be brave enough to try something new!!
  14. by   Neats
    There is a term out there called compassion fatigue, this is a real secondary stress related issue that plagues mostly medical professional, it is associated with the interactions we have with patients on a daily basis. Burn out is related to everything else that goes on in our environment i.e like having to walk down 3 flights of stairs to get to the cafeteria for a lunch break of only 30 mins if you are lucky, or not having lunch on a daily basis because you are always short staffed or dealing with dying patients or those who are difficult and malingering.

    It is recommended that people in these situations get professional guidance. While working in the prison system I developed compassion fatigue, I truly had difficulty in having a thought at times for my patient, I would just follow the policy and had to force myself to ask the patient how they felt, if there was anything I could assist them with their healthcare. I never placed my patients in jeopardy but I did have difficulty dealing with the cries for help disguised as medical when clearly they needed mental health interventions.
    Improving your situation using multiple methods and really acknowledging where I am and what am I doing really helped. I also learned to take care of myself better and developed new boundaries not only for me but my interaction with others.

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