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I’m in a toxic relationship with the ER

Stress 101   (899 Views 16 Comments)
by Wbm33 Wbm33 (New) New Nurse

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I have worked in an ER for a little over a year and a half now, doing permanent nights. I love the adrenaline, the codes, traumas, and really sick people. I’ve been pushed to new limits and gained so much confidence. I learned how to voice my concerns, opinions, and a big one: how to say no and set limits with people. But now, the honeymoon phase is over and it’s not all new and exciting. Daily I feel beaten into the ground. When I try to explain how I feel about my job, the best way I can put it is, “it’s sucking the life out of me.” I used to be a really naive, docile person who wanted to please. I don’t feel that innocence anymore. I feel cold, jaded and emotionless. I still love the teamwork (I work with a great crew) and the codes, critical pts, etc. but I don’t know if that’s enough to keep me in the game. I’m depressed, my sleep is profoundly messed up and I never feel physically energized or well. I love the ER but it’s becoming toxic for me. I don’t want to go into work every day to be belittled, verbally and physically abused by patients and their families. I’ve seen some sad things happen to patients that I have trouble forgetting. I feel like my nervous system is shocked and burnt out. I don’t know where else to go. I don’t want to switch jobs and lose my skills and I will miss to critical care aspect. Yet I don’t want to stay and lose my darn mind. Do other people have experiences like this where they stayed and they got over it? Where else have others gone after ED that gives them a better work-life balance? I feel so lost and frustrated...any response helps!! 

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llg has 42 years experience as a PhD, RN and specializes in Nursing Professional Development.

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You sound like you are starting to experience a bad case of "burn out."   It's great that you can recognize that something is wrong and that you are looking for ways to improve your life.   So ... start by patting yourself on the back for that.

I think the next step in your "recovery" will be the hardest.   In order to move forward and improve the quality of you life, you will need to make some changes.   Most people fight making those changes because they cling to the idea that the way they do things now is the right way.   They have made the choices they have made in the past because they were the right decisions to make -- and doing anything different now would not be a good choice.   But doing things differently (or making changes) is the only way to improve things.   Does that make sense?

If you really want to stay in the ED because you like the nature of the work and the team you work with ... then you will have to find ways to take better care of yourself so that you can better cope with the stresses of the job.   How many hours per week do you work?   Can you cut back a little?    Have you been using your scheduled off time and vacation time regularly ... and using that time to do things that nourish your psyche and soul?    Have you been able to leave work behind when you walk out the ED door?    You will probably need to separate yourself from the ED a bit in order to keep working there long-term -- or it will "eat you" over the years.

Or are you really looking to leave the ED and find another specialty to work in?   Do you think you can stay in the ED and thrive there long-term -- or do you think that finding another specialty is what you really want to do?

Remember -- all specialties have their own set of unique skills.   You won't "lose your skills" when you leave the ED.  Your ED skills will weaken a little, but you will gain a whole new set of skills in a new specialty.   You will become more well-rounded as a nurse as your focus broadens.

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Thank you, llg, PhD, RN. I work 36 hrs/wk now. I stopped doing doubles or any OT to try to scale my hours down. I don’t think my paycheck can afford to cut back standard hours, as much as I’d like to do that. I also can’t afford to lose my night differential and go to days to achieve better sleep. I’m thinking of switching specialties though I don’t know which yet, and doing ED per Diem. I’m nervous that I may regret leaving because I feel like I’m “giving up.” And I’m really stubborn 🙂 I hate feeling like I quit something because it was hard. 

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22 hours ago, llg said:

I think the next step in your "recovery" will be the hardest.   In order to move forward and improve the quality of you life, you will need to make some changes.   Most people fight making those changes because they cling to the idea that the way they do things now is the right way.   They have made the choices they have made in the past because they were the right decisions to make -- and doing anything different now would not be a good choice.   But doing things differently (or making changes) is the only way to improve things.   Does that make sense?

 

I agree with this and am going to take it in a second direction.

You have to come to terms with your thoughts. Your emotions. Your processing of what you have seen and experienced.

IMHO (and the reason that I take a bit of umbrage to most of the superficial self-care advice I've seen), this is going to be a process. It really isn't a "do more happy things and you'll be happier" sort of deal. You need to see the world, see yourself, and put yourself into a different context in relation to the world and the people you are caring for. Your current context is a perfectly natural, but it has become toxic and is now no longer serving your interests.

This isn't going to be just a matter of a vacation or reading a good book or spending time with loved ones or listening to happy music or feeling happy because the sun is shining. Rather, it is going to involve a different understanding of things, a lot of things, and a different understanding of your positioning among them.

Gotta go...will write more later...

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llg has 42 years experience as a PhD, RN and specializes in Nursing Professional Development.

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I agree with JKL33.   Learning to work in a stressful environment without stressing yourself and burning out is a process that often takes a while -- and considerable change in the way you see yourself and your work.   I agree that much of the "take better care of yourself" advice out there is often too superficial to handle the deeper issues that can be involved.   Be prepared to have this take a while.

What other specialties interest you?   Did any appeal to you as you went through your student rotations?   Have you seen any type of job out there that you might like?

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I gave over 12 years to the ER. Trust me when I say, it is ok to leave, it’s ok to want something different, and you can be part of another awesome team. I felt guilt for leaving, but seriously, the ER does not love you back, and you can only give so much of yourself to it before it will do you in. If you’re feeling this now, I’d recommend looking into a day shift in an ICU, perhaps OR, or an area where it’s not a revolving door. (I realize the other area are also busy with their own challenges-the ER just has its own *special* set). 

Edited by TXRN2004
Had another thought

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14 hours ago, TXRN2004 said:

I gave over 12 years to the ER. Trust me when I say, it is ok to leave, it’s ok to want something different, and you can be part of another awesome team. I felt guilt for leaving, but seriously, the ER does not love you back, and you can only give so much of yourself to it before it will do you in. If you’re feeling this now, I’d recommend looking into a day shift in an ICU, perhaps OR, or an area where it’s not a revolving door. (I realize the other area are also busy with their own challenges-the ER just has its own *special* set). 

Oh man you are right “the ER does not love you back.” That puts it in perspective. I put everything I have into that place and its really not giving me much. It’s not worth losing my joys in life over it. Maybe a day job ICU could be a better fit...I appreciate your post coming from someone who’s left the ED. Thank you

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22 hours ago, llg said:

I agree with JKL33.   Learning to work in a stressful environment without stressing yourself and burning out is a process that often takes a while -- and considerable change in the way you see yourself and your work.   I agree that much of the "take better care of yourself" advice out there is often too superficial to handle the deeper issues that can be involved.   Be prepared to have this take a while.

What other specialties interest you?   Did any appeal to you as you went through your student rotations?   Have you seen any type of job out there that you might like?

I think about the ICU, PACU and IR. I worry that I’ll job hop too much which won’t look good on my resume. As a new grad I worked 1.5 years in infusion before starting ED. I was bored to tears and always wanted ED, so it was a great transition. But that’s already two jobs in 3 years. When I started ED I loved it and wanted to retire as an ED nurse. Its disappointing to want to change again so soon. 

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23 hours ago, JKL33 said:

 

I agree with this and am going to take it in a second direction.

You have to come to terms with your thoughts. Your emotions. Your processing of what you have seen and experienced.

IMHO (and the reason that I take a bit of umbrage to most of the superficial self-care advice I've seen), this is going to be a process. It really isn't a "do more happy things and you'll be happier" sort of deal. You need to see the world, see yourself, and put yourself into a different context in relation to the world and the people you are caring for. Your current context is a perfectly natural, but it has become toxic and is now no longer serving your interests.

This isn't going to be just a matter of a vacation or reading a good book or spending time with loved ones or listening to happy music or feeling happy because the sun is shining. Rather, it is going to involve a different understanding of things, a lot of things, and a different understanding of your positioning among them.

Gotta go...will write more later...

You’re spot on. I think staying healthy in this job long term would honestly require a therapist to help me achieve this. It is something that takes work, and not just a few personal days here and there. It would really be changing a pattern of thinking, which is something that is very engrained in all of us. Not an overnight fix. 

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A little more on the topic:

5 hours ago, Wbm33 said:

I think staying healthy in this job long term would honestly require a therapist to help me achieve this.

It may, or it may not. It is something that isn't impossible to work through (depending upon each person's individual situation, of course).

You can slowly change your thinking.

1. I believe it begins with understanding what part of the job is about you, and what is "not you." For example, you are responsible to treat others kindly and professionally. But, their rudeness, downright meanness, etc., is "not you." It isn't about you and doesn't have anything to do with you (provided that you aren't actually instigating or exacerbating tensions in some way). Right?

So that, to me is the first step to freedom. It seems really harsh to write it out in words, but basically you have to understand when something is "not my problem" and "has nothing to do with me." You are responsible for your choices, others are responsible for their choices. You have to learn to not take emotional responsibility for others' choices. This idea extends beyond patients. It extends to coworkers who get bent out of shape about small things, it extends to managers who are unappreciative, it even extends to our own family members sometimes.

People make their own choices, and just as you are responsible for yours, they are responsible for theirs.  You (most of the time) don't "have to" feel angry, defensive, guilty, upset, offended, etc., in response to other people's choices. You can choose positive (or at least neutral) responses/reactions, if a response/reaction is even required.

2. Re-evaluate what you are there to do. People have a lot of problems (physical, mental, emotional, circumstantial, chronic, acute, etc., etc.). You are not there to solve them. You are there to utilize your best professional nursing and interpersonal skills on their behalf. That's it. You apply this thinking to every situation, whether it is someone arriving with chest pain, or someone yelling about what's taking so long.

3. Stop believing that everyone has to be nice. They aren't going to be, and repeatedly getting upset/offended about it is toxic. Just let it go. This ties in with #1...it isn't about you, if you weren't standing there they would be yelling at whoever was standing there instead of you. Some patients yell and are mean, rude, ungrateful, selfish, when it's your day off, too, you just aren't there to hear it. So don't let them offend or insult you - - just decide not to be offended or insulted.

4. I could write probably write many more little thoughts, but I'll wrap it up by saying that the most important thing is to incorporate all of this ^^^ in a positive manner. Think of it as pursuing freedom, happiness and joy. Put a positive spin on everything I just said and that's what it looks like in person. Believe it and live it: Most of what you are dealing with at your ED job isn't about you, people might be nice but there is nothing forcing them to be nice, if they aren't nice it's their choice, and you don't have to be offended. Simple example: Someone has a basic laceration that is oozing a tiny and the family member says meanly, "You wanna DO SOMETHING about the fact that he's bleeding all over?" Response>> "Oh, yes. I see it's oozing a little bit, isn't it. Sure, I can take care of that." 😇

Refuse to climb into the mud pit with them. Just refuse. It isn't worth it. Your life is worth more than that.

Do some mental exercises to start yourself on the track of rethinking things and see where that takes you. 👍🏽😊💮

 

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Career counseling and help from a couple executive friends helped me separate my personality traits from my field of work. 

You mentioned being docile before working in the ED, and the work helped you overcome that. Sounds like you've challenged yourself and succeeded. Now those challenges feel like degradation. I felt the same and left a career I loved. I had to reframe the work, and structure my attitude around taking the bad with the good and find other ways to challenge myself personally. 

Hope this helps and good luck. Don't let a seemingly lack of forward personal momentum take you away from the work that you love and have the gifts for. 

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laflaca has 5 years experience as a BSN, RN.

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On 10/30/2019 at 5:45 AM, Wbm33 said:

 

I'm a former ED nurse too. It was hard to let go, because I was so invested in the whole image of emergency nursing, which other people feed in to. But there's no prize for working the hardest or being the toughest- it's your  life, you don't know how long it'll last, and you should find whatever happiness you can.  What is all the struggle getting you? 

I found other jobs to be so BORING at first. It took months for my brain to recalibrate. Then I was kind of angry.... Like "seriously?? Other people have just been going about normal days, no one dies, no one punches anyone, nothing terrible happens, they're not working at 100% of their physical and mental capacity for hours on end? And they still get the same paycheck and go home?". Then I eventually got used to a more normal life... I say try it, you might like it 🙂

A friend said to me, "just because you're good at something, doesn't mean it's good for you! And it doesn't mean you have to do it either."  I think that sums it up.

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