How can I prevent myself from having a nervous breakdown?

[shabbychic23]

I am a new RN with only 3 months on a med/surg unit. Along with transfers and new admissions, there are time when I have up to 11 patients to care for. The hardest part of the job is trying give out meds within the 1 hour before or after time frame of schedule time frame. Many times I find myself on the 6th. patient still giving out 10 AM meds at 12 PM.

To make matters worse, pharmacy personnel are never punctual with scheduled delivery of medications, especially IVPB. The nurses Aide on my unit aren't cooperative and at times insubordinate when I ask them to go to the pharmacy to pick-up meds. Needless to say this ultimately comes down on me if a med wasn't given or was given late. Another source of stress is the demanding nurse manager on my unit. Since JACHO is scheduled to come to our hospital, she has been nit picking at anything and everything. While I can appreciate her concern it has me extremely exhausted.

Finally, there are the patients who are so demanding. I've had demanding patients press on the call bell so many times that I lost count. Am I there just to serve them as their personal nurse?

Two days ago I just broke down in hysterics in the nurse manager's office. The words were so hard to come out in between the sobs. I told her how older nurses have been less than helpful in sharing their experience. In addition, I told her that I felt that I couldn't live up to her expectations. I mean she seemed to complain about everything. That same day, I ended up leaving early because I felt I couldn't provide decent nursing care to my patients in the condition I was in. I've since been off from work for a few days to recoup.

I love nursing so much, but since I started this job, I'm beginning to question whether or not I chose the right career. I can see why many nurses get burnt out from the profession and I'm afraid if things in the industry don't change, such as less patient to nurse ratio for starters, there will continue to be a high burn-out rate among new nurses.

Any words of advice would be greatly appreciated. :o:bluecry1:

sincerely,

Shabby Chic 23

[Chixie]

Im only a student but i think that you need to switch off when you get home, chill out in the bath with a book and some chocolate otherwise you will go nuts.

[kellykelly]

Honey I've been doing this for ten years but I would be in tears too if I were you. ELEVEN patients? That is CRAZY!!! If your manager is worried about JCAHO coming and making a good impression, she really ought to start with staffing issues. That is unsafe. You can't provide the quality care those people need or get meds given on time or anything else with that many patients.

I work on a cardiac floor and the most I've ever had was 7 patients one night, with an AM admission making #8. That was by far the exception rather than the rule. Most nights we start out with 4 and you might get an admission or you might not. We have a new CEO who's all about patient safety and spending the money to staff floors safely, provide updated equipment, etc. It's really made a difference in the morale of the nursing staff! If you don't see anything change soon you should start looking for another job. If I had to come to work every day facing 11 patients, I'd go elsewhere. It's NOT just you!!!! and it doesn't have to be that way!!

[emilysmom,RN]

I know exactly how you feel. I am almost at my 6month mark and some mornings I go home crying. My mom wants me to go on anti depressants. I realized nursing was a hard job I am in my 40's and have done office jobs, worked in resturants and worked for a vet. THis is the hardest job I have ever had. I think 11pts is dangerous for you and for the hospital not to mention the pts. THey are just begging for a lawsuit and until they get sued or get fined it will continue.

I have no easy answer, just that we are all going thru tough times and I just hope my nursing will click very soon.

Good Luck hang in there

[LilyBlue]

My entire hospital is like this - there are constantly at least ten RN postings open on each unit. It's a very vicious cycle - the patients get more demanding, the nurses get more harried - wash, rinse, repeat.

For this reason, after ten years, I am seriously looking at hanging up my hat on bedside nursing. I am thoroughly sick of it. I wish you well.

[marie-francoise]

11 patients?????!!!! (reminds me of the amplifier in the movie "Spinal Tap") That is CRAZY!!!! Too many patients. And patients & their treatments are all getting more complex, to boot.

I say again - no wonder there is a nursing shortage. Who the heck wants to be in crazy misery every workday?

Bears repeating:

No wonder there is a nursing shortage.

No wonder there is a nursing shortage.

No wonder there is a nursing shortage.

No wonder there is a nursing shortage.

[diane227, LPN, RN]

This work environment sounds very dangerous. I cannot imagine giving a new grad the responsibility for 11 patients. You absolutely cannot work safe in that environment and you don't have to. Most hospitals don't work like this in my experience. Please do consult your EAP. They are wonderful in helping you find the help that you need. I would be interested to know what state your work in and what hospital do you work for. It the hospital not for profit or a for profit? Send me a private email so we can discuss then further.

[Itshamrtym]

I wish you the best!!!! VERY unsafe ratios..... With those ratios something "BAD" will happen. You worked to hard for your license and it is NOT fair to the patients. It doesn't sound like you are getting much support from your co-workers either. Such a shame.. Try to hang in there. The first year is the worst. But, if the situation doesn't change you may have to look else where.

And remember Take care of you!!!!! Good luck to you.. Keep us posted. We are always here to lend a ear.

[RedhairedNurse, BSN, RN]

I know exactly how you feel. I am almost at my 6month mark and some mornings I go home crying. My mom wants me to go on anti depressants. I realized nursing was a hard job I am in my 40's and have done office jobs, worked in resturants and worked for a vet. THis is the hardest job I have ever had. I think 11pts is dangerous for you and for the hospital not to mention the pts. THey are just begging for a lawsuit and until they get sued or get fined it will continue.

I have no easy answer, just that we are all going thru tough times and I just hope my nursing will click very soon.

Good Luck hang in there

I think certain antidepressants are poison....I hate them. I'm sure they're good for some people with diagnosed clinical depression. It's been suggested that I take them too just because of the stress I undergo, but I don't have a history of depression so I'm not taking them.

I started taking vitamin supplements and exercise. I feel much better.

Take care!

[flg8tr]

I hate to say this, but I think the situation you describe is not going to get much better, no matter how many months or years of experience you have. 11 to 1 ratio on a m/s floor is impossible to do safely and you should quit before something happens to your patients due to this unsafe staffing.

Best of luck to you!

[nelcoy4]

I remember going through the same thing when I was a new nurse. I still go through it every now and then. One thing nursing has taught me was to learn my voice. I was real shy when I first got into nursing and looked real young. I also had to learn some time mangaement tricks. Also it is good to communicate a lot to pts so they don't feel forgotten.

These are my techniques I use for passing meds. Keep in mind, I work 7p-7a, so things are a little calmer. In the beginning of my shift I get plastic clear bags. I labled them with the pt name, birth date, and room number. Then I put the meds (I don't take them out of the orig packet) I'm passing at this time in each pt's bag. I also put things I may need in the bag (ex IV flushes, applesause, alcohol pads, pill cup, spoon) If I'm missing something thenI go or send the NA to pharmacy with a list of all the meds I'm missing at that time. I also ask the other nurses as a courtesy if they are missing something. Before I pass the meds I make sure that the orders have not changed. I also print out the list of meds I have to pass for each pt and do my final check in the room. I go in the pts rooms before I give meds and tell them I about to hand out meds. Do they need anything med related (pain pills), do they have to use the bathroom, new water....stuff like that. I also tell them that I will do wound cares or change IVs after I'm done assing meds(unless it's real easy). Then I pass my meds and if they ask me anything while I'm passing my meds I tell them I will get somebody or they have to wait until I'm done. If they need to go to the bathroom I do take them, clean them up, or put on the bedpan. Sometimes I press the call bell or call the nurses station to tell the nursing assistant that the pt needs assistance bc I'm passing meds. The CNAs on my unit know Im real helpful, but the only time I ask them really to do stuff is when I'm passing meds or handling some serious RN stuff.

I know this may seem like a lot, but it really saves me time in the long run. It goes so much faster when I'm organized like this.

BTW 11pts sounds like a lot for day shift on a med/surg floor. Esp with JACO coming. Maybe you can transfer units.

[shabbychic23]

Thanks for sharing your techniques in organizing your work. This is exactly what I am looking for; for other RNs to share what works for them. Thanks again.

[FireStarterRN, BSN, RN]

A lot of people are saying "the first year is tough". Well, I've been a nurse for 15 years and I would be close to a nervous breakdown working under the conditions the OP describes.

There's absolutely nothing wrong with the OP. She sounds like she's having a reasonable reaction to the circumstances. She shouldn't need to see a shrink because she works in a hellhole. The people creating the hellhole need the shrink.