Mental Break or Mental BreakDOWN

Constance7 · Jan 5, 2006

What a night. I also am a night nurse on a floor that feels out of control more that it feels in control. What caught my attention is the patient who was found unresponsive after his dose of dilaudid. 4mg is a lot, how often was he getting it? I have seen at least three people in the last few months go under and the dilaudid seemed to be the reason. I realize that when used properly this is a very effective drug for pain management, yet addiction seems to be on the rise at my facility with this drug. I notice that people who start receiving dilaudid usually go from being doubled over by pain before administration to asking how often they can have it and requesting it right on schedule with no outward apparent pain at all. Just for clarification I am not a nurse who denies pain meds and I try not to be too judgemental, but it does make me wonder. I have a friend who was hospitalized for bacterial meningitis about a month ago. I was her nurse and we were medicating her with dilaudid 2mg IV Q2h prn for a migraine r/t the meningitis. After about three days into her stay she told me the migraine was almost non-existent but she still felt like she wanted the dilaudid because it made her feel so good. This is not a person with a history of drug abuse of any kind. This is a topic I ponder on frequenly as a nurse. We have patients that are full of cancer, end stage, and I have had to beg a doctor to medicate better.

I also have anxiety issues, always have, and I take 10mg of lexapro QD. I am not a person who likes to take meds of any sort but let me tell you this has taken the edge off. I feel a lot better and my house is a much happier place. I realized that I was bringing the stresses of my job home and my husband and three boys were suffering as a result. Just a suggestion though, this is probably not the answer for everyone.

I hope things begin to feel better for you, sounds like a busy floor with a lot happening all at once. Good luck!

classicaldreams · Jan 5, 2006

Dear Here with me,

I can relate to your post. I'm six months into an ICU job and some nights I feel like I get the difficult patients. I've determined that some of it is my inexperience, some of it is the institution, and some of it is just plain true--they are difficult patients.

Few things I keep in mind--my orientation was adequate, just adequate. My unit lacks management and education, and many policies are unknown and misunderstood. Second, I'm a perfectionist and I remind myself on a daily basis that I can't be perfect. Lastly, I've worked as a aide on floors that were much less disorganized and hectic and more team focused. These units are not usually understaffed and nurses don't leave as a general rule. Plan on finding these units and working on them.

Can you switch to working 3 12s? Your work is more efficient, as once you learn your patients for the shift, you'll have them for 12 hours, not 8.

Hope you are feeling better. Sometimes you just need a night off. I'm a little older than most new nurses. I've been there and done that, so I'm no longer beating myself up about mistakes--you are human and problems and mistakes happen to us all.

Hope this helps a little,

Classicaldreams

Hey there. I work 11p-7a 5 nights a week (big mistake there) on a very busy med-surg/oncology/hospice floor. I honestly feel like the stress that I get from this job is not worth having the job itself. I have been a nurse since July. Granted, I am starting to feel more comfortable, but it seems as if the nights where I think "I have never had a night this bad", always seem to get their match. The past few weeks have been horrible and yes I was warned it'd be bad for the holidays, but come on. Honestly, all I can say is I am sick of the sick people. I got someone to work for me tonight because I just needed a night off. I don't even care about losing money anymore. I have become so secluded, miserable and depressed since starting this job. I have always hated public places (dx with social anxiety a few years back) but now I completely avoid them. Our grocery store is open 24/7 and I find it perfectly normal to go shopping at 1am on a night that I have off, to avoid people. I am so worn down and "burn out" already but I feel like I don't have a right to be because I just started. I am working with nurses who have been on this floor for 20+ years. It seems as though the patient load and acuteness just seems to be getting heavier. Last night we had 32 patients on our floor. I was one of the lucky ones who only got 6 patients, not 7. One has been having blood glucose problems for 2 days. She starts acting VERY WEIRD. I do an accu check and its 527, wow ok. Do another and its 208. Wait 15 minutes do another and its 68. Send down a STAT blood glucose draw, which takes a freaking half hour to come back, and its 36. She got 1/2 an amp of D50 only to be back at 50 by 6am (she got the d50 at 2). One completely dependent who keeps making me call his wife at ungodly hours. One who needs assist to BSC and takes what seems like hours to shuffle over to it. Pain meds after pain meds after pain meds. Some nights I think that's all I do. 32 year old male accidentally pulls out IV at 3am, very pleasant, completely oriented "got it caught on his bed". Ok, I like this patient, I don't let it bother me too much. Get the IV back in and he gets his prescribed 4mg Dilaudid at 0415. 0700 he is found unresponsive when someone goes in to get him into a wc to go down to ultrasound. I am in completely dependent man's room on the phone with his wife when I hear "Code One room 520". I am like WHAT IN THE WORLD IS GOING ON!?!?! 32 year old completely normal man all night long. They are blaming the Dilaudid. He had it twice before that and was fine, plus it was 3 hours after he had it, but ok. Most days I'm just glad that everyone's alive when I leave in the AM (if they are). I have seen so many horrible things in these past few months, felt so stressed, so broken down, so wanting to just quit, that I am wondering how in the world anyone does this for so long. This is such a love/hate job for me. Is this how it will always be? It's like it's either really good, or REALLY BAD. I seem to have more of the REALLY BAD. The other nurses on nights have even made comments before that "wow you always get the patients with issues". By the way, that guy was alright. I was helping to wheel him down to the ICU at 0720 (and yes I'm supposed to be leaving at 0730). Oh the joys of nursing.

ColdFusion · Jan 5, 2006

Just a few thoughts:

Are you making full use of your nurse aides?

Are you letting others know when you feel swamped?

The other nurses have evidently noticed that you have been having a lot of difficult patients.

Talk to your unit manager. Tell her how you feel. See if you can come up with some things that will tide your over and get you through.

I know the holidays were rough even where I work, acuity went through the roof.

I agree about going to twelve-hour-shifts, they are much easier to deal with than 5 eights. I do 3 twelves in a row but then I have four nights off. May not be an option for you now but make a note if it for future reference.

jimthorp · Jan 6, 2006

Check the insulin expiration dates.

CrunchRN, ADN, RN · Jan 6, 2006

You poor thing! Five 8 hour nights will kill you. Not enough recovery time. I would decrease my shifts per week, or change to 12's, and if they will not accomodate that need then look elsewhere. Unless you have done 8 hour nights 5 days a week you just have no idea how rough it is. Good luck to you!

chachh, BSN, RN · Jan 6, 2006

I feel your pain.

I am a new graduate from June. I had been told that at about six months in you could expect to hit a wall and wonder "what the heck am I doing here?"

I hit it.

But I am just going to keep plugging along, because I think I will find it may just be worth it in the end.

And remember, there are a lot of different opportunities out there besides floor nursing! Hang in there!!!!

DidiRN · Jan 7, 2006

What a night. I also am a night nurse on a floor that feels out of control more that it feels in control. What caught my attention is the patient who was found unresponsive after his dose of dilaudid. 4mg is a lot, how often was he getting it? I have seen at least three people in the last few months go under and the dilaudid seemed to be the reason.

You know, in my area, Dilaudid was a drug that was almost banned for many years (was still available but rarely if ever prescribed)...for the very reason you just stated above. Then suddenly BAM...now I see it's the most popular pain medication now prescribed in hospitals nowadays.

I vividly remember working floors about 10-12 years ago that put people on continuous pulse oximetry who were receiving Dilaudid, due to deaths from it. I remember floating to a urology floor, and saw several young men admitted with kidney stones, who had these cont. pulse oximeters on. They had had a patient die from Dilaudid so every patient who came in with a IV Dilaudid order got a pulse ox along with it.

Not real sure why it's now popular again, but it sure seemed like back then it was quite a dangerous drug to people who weren't on the vent.

Daytonite, BSN, RN · Jan 7, 2006

I understand your frustration. When I started working full time at a hospital job I began to feel much the same as you. A big part of the problem is that hospital patients are sick--it's that simple. The other part of it is that they are all congregated into one place--the hospital--and particularly, the unit you work on! You won't see many well people in the hospital, that's for sure. What got me really bummed was seeing a parade of young 30 year old women dying of breast cancer and having open necrotic wounds of their breasts because they had declined early treatment (this was about 27 years ago) on the unit I worked. I was distraught at how ill these women were who were just a little bit older than myself and they were dying as well!

The first thing you have to do, I guess, is realize that you are going to be surrounded by very ill people who need nursing care at many levels. That's just the way the hospital organizes it's patients. Secondly, you have to intellectually realize that this is not the norm of society. By far the largest groups of people in our society are well.

There are two things I think you can do. (1) is to find a job on a unit that is not as depressing or where there is less direct patient contact such as the OR or some specialty type of nursing like IV Teams or working in a cath lab. Working with and being responsible for only one patient at a time is so much easier to handle. (2) is to go back to school and work toward your BSN. A deeper understanding and development of your nursing skills will help you deal with many of the frustrations you are now experiencing. It made all the difference in the world to me. Part of your frustrations are coming from inexperience and mastery of your role as an RN. You still have a great deal to learn about being an RN. As a BSN you will have more opportunity to get into supervision and administrative roles which have less patient contact as well. But I must also tell you that you will be swapping the kinds of problems you now deal with for employee problems that are just as frustrating, although not life threatening.

I know you feel that you, in particular, seemed to have been dumped on by whatever power exists in the universe, but I am going to suggest that you try to look at all these many incidents that you have as learning experiences. When you are able to confidently handle these problems that come up one after the other, and that comes with experience, your attitude will be much different.

Whatever you decide you want to do, don't even consider leaving the profession because there is a perfect fit out there for you. Sometimes you have to try on many different shoes before you find the perfect fit. I wish you the best.

Indy, LPN, LVN · Jan 7, 2006

Daytonite, if you'd write a book with all that wonderful advice in it, I would keep it with me for when I need a little encouragement. Sorry to derail the thread!

RainDreamer, BSN, RN · Jan 8, 2006

Oh wow, I'm so sorry you're having such a hard time. I totally agree with CrunchRN about the 5- 8 hour shifts. That's got to be killer! I work 3- 12s and it's really not too bad ..... of course I have my bad nights and feel exactly like you do where I just want to quit and wonder if I'm always going to feel like this. But I have 4 days off that I don't have to go into work, that I can relax at home and enjoy time off. I usually work 2 nights, 3 nights off, 2 nights, 3 nights off, etc .... sometimes 2 nights off in between. After having 2 or 3 nights off in a row I'm usually ready to go back ..... I feel refreshed and recovered. Working 5 days a week would burn you out fast .... and it sounds like you're already getting to that point.

I would definitely start looking into working 12 hour shifts, or look into working somewhere else. One thing about nursing is that you don't have to feel trapped in a certain position ..... there are so many options out there. I wish you all the best of luck ..... please help yourself, you don't need to feel like this. ((((HUGS)))) for you.