Help! I don't want to get burned out! Thinking of switching my specialty

[turntport]

So I've been a nurse for 3 years now and absolutely love what I do. I currently work home health but I've worked in a few other specialties in the past. I've always loved home health but I now have 3 primary patients that I see on a regular basis that are starting to tax me mentally. The problem is that none of these patients want to work to improve their health. No matter what anybody says or does (family, doctors, other nurses, etc), they remain noncomplaint and become agitated when you try to encourage ANY type of change. So this may sound crazy but my question is this, do any of you work in a field of nursing where your patients are ambitious about getting better? I still love what I do, but it's just not as rewarding as it once was. That's why I think a change is in order. Any suggestions? Thank you in advance!

[Passion8RN]

I've been a nurse for a total of 13.5 years between LPN and RN. I have come to accept (after a long time) that there are going to be patients that just don't want to change, no matter how much education you provide, or how much you care. I accepted my powerlessness over this. Now, I try to focus on the tiniest of tiniest changes (taking meds at least 5 days a week as scheduled, maintaining dr appts, drinking water more than soda or booze :), using their nebulizers as scheduled, turning off oxygen while smoking, etc.) Appreciate the small changes and continue to provide incredible nursing care. I can tell you do actually care for your patients and are not there just for the paycheck, like many home care nurses I have worked with in the past are, so keep doing it and feel rewarded by the minute changes!

[Libby1987]

I've been a nurse for a total of 13.5 years between LPN and RN. I have come to accept (after a long time) that there are going to be patients that just don't want to change, no matter how much education you provide, or how much you care. I accepted my powerlessness over this. Now, I try to focus on the tiniest of tiniest changes (taking meds at least 5 days a week as scheduled, maintaining dr appts, drinking water more than soda or booze :), using their nebulizers as scheduled, turning off oxygen while smoking, etc.) Appreciate the small changes and continue to provide incredible nursing care. I can tell you do actually care for your patients and are not there just for the paycheck, like many home care nurses I have worked with in the past are, so keep doing it and feel rewarded by the minute changes!

Exactly.

There are small wins to be had, if not with the patient then with the caregiver. If not there, then in the advocacy. And if you still can't find it, then it's in their knowing that you gave them your best, which patients often don't perceive in today's rushed healthcare.

[ruby_jane, BSN, RN]

No matter what anybody says or does (family, doctors, other nurses, etc), they remain noncomplaint and become agitated when you try to encourage ANY type of change. So this may sound crazy but my question is this, do any of you work in a field of nursing where your patients are ambitious about getting better? I still love what I do, but it's just not as rewarding as it once was. That's why I think a change is in order. Any suggestions? Thank you in advance!

Kudos to you for acknowledging how you feel about this. It's not crazy. However (and I say this to myself every day) you cannot care more than your patient does about the patient's health.

Google motivational interviewing. I did this when I had a noncompliant diabetic who drove me up a wall. The premise is that our patients are ALREADY aware of what they NEED to do. There's just not a reason for them to want to do it. In Motivational Interviewing your job is to figure out what their catalyst for change might be. Also Motivational Interviewing will change your mindset from "they're noncompliant" to "what motivates them to change." For my school-aged diabetic, the promise of having lunch outside if his BSG was WNL at lunch actually worked. For a minute.

Your other choices: ask for different patients or consider another ambulatory care specialty like public health or school nursing. Don't let the stuff you can't control dampen your enthusiasm. We need nurses like you!

[SpankedInPittsburgh, DNP, RN]

I worked in an ER for a long time. It's where the noncompliant patient usually lands as the result of his noncompliance. Many nurses get frustrated about this issue. However, you have to recognize they are autonomous adults who are allowed to make bad decisions. I don't let their noncompliance distract me from my job. I treat them the best I can to include education I know is probably falling on deaf ears. Many times I've told a patient "nobody is or should care more about you than you" meaning yes Mr / Ms Chronic Disease Patient you can do what you want but recognize that others are doing all they can for you and offering you another way to live. You choose to continue in your life as you see fit but do not moan about the consequences or be seduced by the siren song of denial cause I ain't hearing it.