I HATE my job! HELP!

[mamabb]

I need advice in a HUGE way! I became a licensed RN this spring and obtained a position on a Cardiac Step-Down in April (2012). We deal primarily with open-heart patients and post-cath patients, of course a telemetry unit. Prior to getting my license, I'd worked in home care for 7 years. I loved the one-to-one relationship (I only had 2 clients during that 7 year period), but did miss a more fast-paced environment, as well as working with others. Tele wasn't my first choice, but I knew it would be good experience and took the advice of a friend (who has worked on the unit for 6 years) that if I didn't want traditional Med/Surg that this would be an option to gain some experience.

Experience I'm getting, no doubt about that. Our unit is unique in that we do a HUGE number of admits and discharges (14 were admitted last night between the hours of 7pm and 9:30pm, most discharges occur during the day, of course). I love the people I work with, both day shift and night shift, and I know how rare that is to have such a cohesive crew. We are fortunate to be in the newest tower of the hospital, all private rooms, etc.

All this aside, I am miserable. I have always been known as the super type-A person that needs a certain amount of stress in my life, often taking on several challenges at once (for example, working full-time through nursing school, all while having two young children, volunteering two days a week at their elementary school, getting diagnosed with CA and having a hysterectomy at 28) and never losing my cool. I don't get anxious, bent out of shape... always use that bit of stress to push me harder... and it's always worked; until now. I have now had 3 panic attacks, the last one occuring just prior to receiving report at work. I sought out help from my doctor when the first one happened, about 6 weeks ago, and we agreed to try 0.25 of Xanax, to which I only took a half of that on my way to work, simply to curb the physical symptoms I had been experiencing. That worked for a few weeks, though I still found myself almost obsessing about the thought of going back to work (even on my awesome 6 day vacation to the beach!). This past Thursday I had the worst attack of all, ended up taking the other half of the 0.25 and still could not calm myself. I saw my doctor yesterday, and after knowing me for 10 years he suggested that I honestly seek a new unit. I feel he is right, that going on an anti-depressant just to maintain a position on a unit doesn't seem sensable, especially since I don't have these feelings at home. Everything else in my life is going great, not a complaint.

My question to all of you is what units/experiences you may suggest to me. What I don't like about my unit is:

---TELE- my phone blowing up all night causes me HUGE anxiety, which some people say will subside, others seem to still feel nervous about

---Getting so many admits as soon I walk in the door; I don't mind having many pts, it's the unsafe feeling I have when I get pts with sheaths still in place, knowing I have to pull them and still have 5 or 6 pts to see (and like last night, two had just gone into Afib and needed medical mgmt ASAP)

---Teaching (this doesn't cause me anxiety, just a bit of info to maybe help you understand what I MAY like) about cardiac issues... bores me in the worst way!

The Tele and admits are the main two issues I have, and am extremely open to any/all suggestions. My hospital doesn't allow for transfer until 6 mos, which for me is in October. I don't necessarily want to move hospitals, but am willing to do so if it means peace of mind. Nursing is not a low-stress field, in general, but I feel that perhaps if I had SOME passion for the type of nursing maybe it wouldn't be so awful.

The nurses on my unit say that even with my anxiety I'm doing well... but I feel I am just going through the motions and can't stand bringing it home with me. I am open to an outpatient setting, clinic, office, other hospital specialties. I know many of you have experienced what I'm going through or know of others that have... your input would be so appreciated! My career is secondary to my home life, health and well being. I don't want to feel like garbage on my days off, dreading my upcoming work days... My family deserves the old mom/wife back that didn't dwell on anything; and, I LOVE nursing, I truly do. LOVE helping, caring, teaching people how to care for themselves, sharing my knowledge, and also challenging myself, just not so much that I am emotionally spent. I KNOW there is something better out there for me!

Thank you!!!!!

[Nurse ABC]

When I first started as an RN many years ago I absolutely hated the floor I was on too! To this day, it still remains the worst floor I've ever worked on, for me anyway. We also had a six month policy so what I did to get through (after orientation) was to stay on the same floor but went to part-time weekends until my six months was up. During the week I worked Home Health and floated at the hospital in order to make ends meet. Maybe you could do something similar to get you through without having to leave. Just not being there so much helped!

[mamabb]

Thank you for your quick response! You know, that's what a few people have suggested, finding something else and switching to part-time. I'm actively putting out applications now, so maybe that is a good idea. I also think it's a good way to "test drive" another area! I know I'm not the first person to go through this, and am confident something will be the right fit :) I have stopped working 3 in a row, doing 2 on, 2 off and then 1 more... that starts this week, so we'll see if that helps, too! Thanks, again:)

[nurse2033, MSN, RN]

Try to find a way to appreciate what you are doing. Sometimes you just need an attitude adjustment to get through. I did this at a job I hated and found a way to continue, but it wasn't the job that changed, just my outlook. As you get used to the job your anxiety will get less. It is much better for you to continue than bail. You will fell better about yourself and it will look better on your resume if you decide you must leave. Best of luck.

[joslina]

i agree with nurse 2033 sometimes if you have a negative attitude going into it it is hard to change that. with that said...having patients with lines in and still having 5 or 6 other patients is NOT SAFE!! have you talked to your supervisor about that assigment? if that gets you nowhere i would go up the chain of command, it would be interesting how many mistakes have been made when given an assignment like that. the patients safety must come first and if that is jepordized i would be speaking up!

[mamabb]

Joslina--- in my super long winded post I forgot to mention how much I believe that attitude is MORE than half the battle. In this situation, I haven't had luck with the attitude department. I am known to be a glass half-full person, and my anxiety is causing me to feel like I'm in such a rut. On that note, I do believe that alot of my anxiety comes from feeling like I'm in an unsafe environment. Much like what you said, that assignment was awful. Unfortunately, I wasn't the only one with a crazy assignment. I can't say every single day is awful, but out of 3 days I usually have two bad days. I think I will keep applying and seeing if I can come up with a part-time position. Many of the nurses on my unit suggested that, as well... it will allow me to be there less, while still sticking it out until at least the six-month point. My hope is that maybe if I am there less, I will learn to handle the unit better and become less anxious. Thank you so much for your input, it helps to hear that others think assignments like that are unsafe. Unfortunately, I think the nurses on my unit (many have been there more than 7 years, the unit used to be a sister unit to our cardiac outpatient services unit where are the caths come from, but three years ago it was moved to its own unit...) are used to all of this since they used to pull lines regularly when they were a part of the other unit. However, that said, they stopped pulling lines regularly because too many issues came up. It's different when the pull in COS, they have doctors right there should something go wrong, a luxury we don't have. I will keep trucking, and hope in a year or two that I'll be able to see this as a learning experience and not just a dreadful time:)

[Been there,done that, ASN, RN]

Your stress is due to an acuity level/ patient ratio that is not the standard and not manageable.

The turn over rate , along with the necessary level of nursing care is not acceptable.

The combined responsibility of sheath removal, unstable patients and admissions is ... SIMPLY OUTRAGEOUS ! (Can you call a rapid response for assistance)?

Your facility is trying to implement this scenario .. at the cost of patient safety. Your ratio should be at the most 1:3.

Combine that with your inexperience in the area and your anxiety is perfectly understandable.

You won't be able to change this ridiculous experiment by administration. They WILL end up shooting themselves in the foot.

In the meantime, any position that requires you to self medicate (especially a tough cookie like you).. certainly requires a STAT move on your part.

Good luck , keep us posted. PM me anytime.

[Hoozdo, ADN]

The combined responsibility of sheath removal, unstable patients and admissions is ... SIMPLY OUTRAGEOUS ! (Can you call a rapid response for assistance)?

Your facility is trying to implement this scenario .. at the cost of patient safety. Your ratio should be at the most 1:3.

I totally agree with the above, especially for femoral sheaths. I have worked at some hospitals that require two RNs in the room to pull a femoral sheath. Things can get pretty hairy pretty quickly pulling from a femoral site. These patients are kept in an ICU instead of tele in my experience.

[Indy, LPN, LVN]

My first job was telemetry. Most of the assignments were 4 or 5 patients, and you could have more than one patient with a sheath in. With that said, they found a solution. They had a position for a "sheath puller" where it could be any of the nurses on the unit who had been trained in pulling sheaths. That person worked 10am to maybe 10p, sometimes a lot later if things were bad. What they did was come in, print the cath lab schedule for the day. Call the cath lab to see if any emergent or cancelled. During the day, they follow where the patients went: Home, (sheath pulled in CoA unit) tele or ICU. Find the patients, do an activated clotting time on them at bedside ( so there was also maintenance of the little machine thing), and when rest is over and ACT is good, pull the sheath. They would get the patient's nurse, or maybe a nurse who wasn't busy, to be in the room with them.

Sometimes the sheath puller would be less busy and do some of your q15 min. pulse/vs checks for you right afterwards. It was very, very nice. They also had the staffing beeper during their time and would stop around dinner time and do the unit assignments and make sure to call people in if it was needed. Before going home they would give the beeper to one of the night nurses to cover in case of callouts for the next dayshift. Your unit sounds like it could benefit from this type arrangement; feel free to bring it up with your manager. We also kept logs of patients and their outcomes, like RP bleeds, hematomas, surgical revision, whatnot. We knew who did a good job with pulls because we kept track of whose patients bled and whose patients did not. It greatly increased the nurses' ability to care for their patients because they could always find someone to sub for them in a room with a pull, if needed, and they weren't regularly tied down in a situation where they could not do anything else.

[Anna Flaxis, BSN, RN]

I worked on a tele unit like this, with a ratio of 1:5, sometimes with more than one sheath, and the primary nurse was expected to pull the sheaths. We often did it alone, plus our own Q15 VS and groin checks (we used continuous doppler monitoring for the pulse checks). The rapid turnover of patients is part of the nature of this type of unit. The patients that stayed the longest were our medical overflow patients. I would not suggest a surgical unit for you, because with hospital stays getting shorter and shorter for post-op recovery, you'll probably see a high turnover there as well. Plus, the ratios on those units can be insane. I think a straight ahead medical floor might give you more the experience you are looking for. You might have some heavy workloads, but I don't think the turnover rate is quite as high, you certainly won't have any sheaths to pull, and you won't have any vasoactive gtts, since those all go to your tele unit.