Is it me? Is it the job? Why is my confidence so low?

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I have been an RN for 2 years now. I work on an oncology floor, but we have recently become overflow for other needs as well. Not only are we stretched thin as it is with just our oncology/comfort care/hospice patients, we also have to provide care to any type of patient from stroke to GI bleed. It's safe to say that we have literally become the dumping grounds of the facility. We are short staffed all the time, the demands are so high from mostly family members and NOT the patients, we have to sign hourly rounding sheets in the patients room REGARDLESS of the acuity of other patients who require total care rather than someone who is a "walky/talky" and is totally independent...I am so stressed and have started dreading coming to work now. I used to laugh and smile and enjoy coming to work, the same as my coworkers. Now we ALL dread coming to work and the tensions are so high that you can cut it with a knife. I try my hardest to make sure my patients are taken care and have what they need. I try so hard to make them all content. I have found myself questioning my confidence and my ability as a nurse due to family members who aren't getting what they want and what they think the patient needs when they have NO idea whats really going on....It's just draining me emotionally to the point where it is effecting my drive at work. Is it me as a person? Is it me as a nurse? What do I need to do different??? Please help!!

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Specializes in Ambulatory Surgery, Ophthalmology, Tele.

I went through the same thing a year ago. I loved the team I worked with but the hourly rounding, short staffing, and increasing acuities (our unit was transitioning to a stroke unit), I knew it was time for a change. I was burned out, getting bitter and that just wasn't me. I had stayed an extra 6 months longer than I wanted because I enjoyed the team I worked with.

I finally decided to make the change and went to an ambulatory surgery center. I LOVE it. It is a different kind of nursing but still very rewarding for me. I wrote an article about it last year in the Nurses Rock section here on AN called "Discovering my dream job" if you want to read more about it. I'm on my phone so I can't post the link.

Good luck to you.

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I have been an oncology nurse for 10 years - although the last year has been as a travel nurse and as such I have worked on med/surg units as well.

Here is my input from my 10 years working in various hospitals, various states, and various nursing units: First, oncology tends to become the dumping ground in all hospitals. Not sure why, but they all do it, apparently. I suspect that oncology is not the money maker for the hospital that other types of units are and so they get pushed to take a larger variety of patients. I would hope that the bigger, nationally recognized oncology hospitals are an exception, but I worked in one of the top 10 in the nation and we were the dumping ground as well.

Here is the most honest information I can give you about the rest: I have walked away from nursing 3 times now for all the reasons you have listed and a few more. I came back to it because I realized that SOMEONE has to take care of the patients. So thats what I focus on. I take care of my patients. I make sure I chart the important stuff. Hourly rounding sheets? We have them too. I don't do them. They are insulting. I take care of my patients - I can't stress that enough. I love them and they can feel it and it makes all the difference in my nursing experience. The longer you are a nurse, the more of a comfort level you will have about not doing everything "by the book". Medicine is an art - not just a science. You learn to trust your gut. Do I do a head to toe assessment on every one of my patients every time I work? I would be lying if I said yes. Sometimes its not possible. BUT, I do spend enough time in my patients rooms to assess them and do the head to toe on the ones who need it. If I have followed a nurse I trust - I often take their word on some things. If I don't like how something looks, I assess further. You will get a feel for all of this. But if you walk in your patient's room with a genuine smile and a friendly attitude - it will go a long way. And if something just doesn't feel right - believe it. Grab a more experienced nurse, if necessary. Nursing is not something we do all alone - we need each other, sometimes just another opinion.

Cancer patients are scared. They have an illness that feels out of control because it is out of their control. Their only hope, as they see it - is the medicine offered by the hospital. So they try to control what they can. Let them. Offer control to them when its appropriate. Even the small stuff - do you want your door open or closed? Lights on or off? IV or pill pain medicine? As you speak to them, don't be afraid to touch them - even hold their hands. It makes a huge difference. It probably isn't coming across in this post, but I have a huge sense of humor and when appropriate - I use it. Laughing makes ppl feel better. Once I wore a nurse cap from the cabbage patch kids place all day. When I went in my patients rooms, the first thing I would say was: "I want you to know that you have a real nurse today, cause I'm wearing this hat to prove it". They loved it. Okay, if someone codes, take off the hat - but u get it!

Don't be afraid to refuse a larger patient load than you are confident in caring for. 5 is usually my limit, although if not acute, I'll take 6 - with a CNA working. If no CNA, then I don't take that many. You are within your rights to do this. Some hospital personnel (read the bosses) can try to bully their staff into taking more patients. In TX, where I currently live, there is whats called Safe Harbor, which protects nurses from having to act contrary to what, in our best nursing judgement, is in our patients and our own best interest. Sometimes it just takes the first nurse to say "no, I'm not comfortable with that", and others will say so too.

And, at the end of the day, if I'm working somewhere and I am prevented from taking care of my patients in a competent and caring way because of unrealistic demands, then I have no problem looking for another job. I don't say this lightly, but I have done it more than once. Nursing - taking care of people when they are at their most vulnerable- is too important and too precious to be treated as a commodity and patients as "numbers". These are our brothers and sisters who are trusting us with their lives and they deserve our best. And we deserve a work place that allows us to give the best we have.

I hope you can find your way through this, it isn't easy, but it's important.

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Specializes in LTC, assisted living, med-surg, psych.
I have been an oncology nurse for 10 years - although the last year has been as a travel nurse and as such I have worked on med/surg units as well.

Here is my input from my 10 years working in various hospitals, various states, and various nursing units: First, oncology tends to become the dumping ground in all hospitals. Not sure why, but they all do it, apparently. I suspect that oncology is not the money maker for the hospital that other types of units are and so they get pushed to take a larger variety of patients. I would hope that the bigger, nationally recognized oncology hospitals are an exception, but I worked in one of the top 10 in the nation and we were the dumping ground as well.

Here is the most honest information I can give you about the rest: I have walked away from nursing 3 times now for all the reasons you have listed and a few more. I came back to it because I realized that SOMEONE has to take care of the patients. So thats what I focus on. I take care of my patients. I make sure I chart the important stuff. Hourly rounding sheets? We have them too. I don't do them. They are insulting. I take care of my patients - I can't stress that enough. I love them and they can feel it and it makes all the difference in my nursing experience. The longer you are a nurse, the more of a comfort level you will have about not doing everything "by the book". Medicine is an art - not just a science. You learn to trust your gut. Do I do a head to toe assessment on every one of my patients every time I work? I would be lying if I said yes. Sometimes its not possible. BUT, I do spend enough time in my patients rooms to assess them and do the head to toe on the ones who need it. If I have followed a nurse I trust - I often take their word on some things. If I don't like how something looks, I assess further. You will get a feel for all of this. But if you walk in your patient's room with a genuine smile and a friendly attitude - it will go a long way. And if something just doesn't feel right - believe it. Grab a more experienced nurse, if necessary. Nursing is not something we do all alone - we need each other, sometimes just another opinion.

Cancer patients are scared. They have an illness that feels out of control because it is out of their control. Their only hope, as they see it - is the medicine offered by the hospital. So they try to control what they can. Let them. Offer control to them when its appropriate. Even the small stuff - do you want your door open or closed? Lights on or off? IV or pill pain medicine? As you speak to them, don't be afraid to touch them - even hold their hands. It makes a huge difference. It probably isn't coming across in this post, but I have a huge sense of humor and when appropriate - I use it. Laughing makes ppl feel better. Once I wore a nurse cap from the cabbage patch kids place all day. When I went in my patients rooms, the first thing I would say was: "I want you to know that you have a real nurse today, cause I'm wearing this hat to prove it". They loved it. Okay, if someone codes, take off the hat - but u get it!

Don't be afraid to refuse a larger patient load than you are confident in caring for. 5 is usually my limit, although if not acute, I'll take 6 - with a CNA working. If no CNA, then I don't take that many. You are within your rights to do this. Some hospital personnel (read the bosses) can try to bully their staff into taking more patients. In TX, where I currently live, there is whats called Safe Harbor, which protects nurses from having to act contrary to what, in our best nursing judgement, is in our patients and our own best interest. Sometimes it just takes the first nurse to say "no, I'm not comfortable with that", and others will say so too.

And, at the end of the day, if I'm working somewhere and I am prevented from taking care of my patients in a competent and caring way because of unrealistic demands, then I have no problem looking for another job. I don't say this lightly, but I have done it more than once. Nursing - taking care of people when they are at their most vulnerable- is too important and too precious to be treated as a commodity and patients as "numbers". These are our brothers and sisters who are trusting us with their lives and they deserve our best. And we deserve a work place that allows us to give the best we have.

I hope you can find your way through this, it isn't easy, but it's important.

THAT ^^ should be required reading for every nurse. Bravo!!!

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Thank you so much!! This has helped me put a whole new perspective on things. :)

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It reads as though you have obtained all there is from this job type and it signals a definite need for a change. Now that you have experienced that potpourri job, you will be refreshed with what another job can offer. The opportunities are endless. Just take that job as a notch in your belt.

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'Is it me as a person? Is it me as a nurse? What do I need to do different?"

It's them not you;) You are overworked to the point of burnout.

Focus on the part of your job that you like, while looking for a position that will work for you.

(Those hourly rounding sheets can be checked off very quickly at the end of the shift)

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