New Grad Burn Out

[WickerRN, BSN, RN]

Hi everyone I fee like I am burning out. I work on a med-surg/psych floor that is know in the hospital as a dumping ground. To give you an example, whenever we get a float in my unit, the floats will always say things like “how can you work in this unit” “this unit is so heavy” or when I float they will tell me when I’m in their unit “this must be like paradise for you”. Unfortunately, this is the only unit I have ever worked in (can’t compare) in 8 months that I have a been a working RN on DAY shift. Recently, the hospital had leadership changes at the very top and ever since then we went from 1:4 nurse to patient ratio to now 1:5 nurse to patient ratio. The types of patients we get are total care, psych, or both. The acuity is very high , we are a top hospital with high census everyday and we have patients that should be in PCU but cannot be transferred because there are no beds. Since the change, my typical day is with 5 patients and average 2-3 discharges and admitting 2-3 patients a day. On my unit if you discharge someone you will also be admitting one. There’s this push now to discharges patients before 10am (in the middle of med pass and assessment). Another thing that’s been added on for us is that we to do nebulizer treatments like dunoeb which can take time.

We have CNAs but they also had an increase in ratio and honestly some of them are not very helpful and are just on their phone even though I delegate tasks they can take their time. Some are great, even with the great CNA’s it’s still an awful unit. We have no break relief nurse so I’m always working on my lunch. My manager knows that it’s been crazy in the unit so she buys us food to make up for it and everyone sees right through it. I’ve received warnings for staying past my shift with overtime and have been told I need better management skills if I am going over my regular shift. Even nurses who have been in the unit for decades have been complaining. Another thing I do not like is that I am given the hard patients, I once heard the charge nurse who made the assignment say “well at least I didn’t give you Jane Does assignment that’s a hard one” or a new grad friend of mine telling me she had someone in my unit float to them and she asked her how I was doing and she said something along the lines “she’s doing great, but I notice they give her all the bad patients because shes good with people and doesn’t complain.” It’s true, I suck it up and just do it. However, it has taken its toll on me. I do not even want to bring this up to my manager because I know it’s not going to get anywhere because the charge and my manager are close friends. Plus, this has put a bad taste in my mouth.

My one year is coming up and I would like to move on to a different hospital altogether, but I am on a 2 year contract. Is it worth breaking the contract for the sake of my mental health? I hate going to work and hating nursing all together. I know I am a great nurse and have received compliments from my patients even my manager keeps telling me to make sure I don’t go anywhere and stick the unit out for 3-4 years before going anywhere else. I don’t think I can. Sorry for the wrong rant, but hoping others were in similar shoes and the grass was greener.

[Jedrnurse, BSN, RN]

This describes so much of what's wrong with our institutions.

Increase the ratios, then admonish people when it takes longer to do their work. Oh, and shackle people with those ridiculous new grad contracts to boot.

Wouldn't it be a nice change if someone wrote "we recently had a change in ownership/management and things have gotten drastically better."

Never seems to happen...

[ruby_jane, BSN, RN]

Good news: 4 months to go before you get the magic "12 months of experience."

Is there any other floor you can change to? What happens if you break the contract? Sometimes mental health is worth more than money. But stay for a year. Hang in there.

[Matthew RN, MSN]

My first job was kind of a similar situation, as I was leaving after 2.5 years they had hired a couple travelers because of how short staffed we were. One of the travelers after a couple days said, "I should be getting hazard pay on this unit it is so bad." My next job was quite a big easier and nicer. If the other nurses in the hospital considers your unit worse than many others it is probably true.

Things I suggest in this situation:

1) Read up on what to do about "compassion fatigue".

2) Decide what you like and don't like about nursing, there is probably a nursing job that you would love, but it sounds like this is not it.

3) Stick up for yourself in an assertive (not aggressive) way. Even if manager and charge nurse are friends if you become a squeaky wheel it will help. Charge nurses often will give assertive nurses more fair assignments. It sounds like the manager would be interested in making you like your job more, there might be some small things that would make you happier.

4) Look at other units in the hospital you might be more happy at. Most of the time even under contract you can change jobs within the same hospital after 6 months. I wouldn't suggest looking at any unit that is unprofessional enough to give float nurses a worse assignment just because they aren't assertive.

5) You asked if you should break a 2 year contract to leave, can you afford to? If you are seriously considering this then first contact HR, find out how they prorate the penalty, is it by the month worked or the 6 month worked? Sticking it out to the year mark should get the penalty down to 50%. If you really hate your job that much it might be worth breaking a contract and taking the financial hit.

[NightNerd, MSN, RN]

Big hugs! I work on the same kind of unit and it's a bear sometimes! I can't imagine routinely having five or six of these kinds of patients.

Definitely speak up for yourself in terms of assignment fairness. We can't do good work if we're mired in an impossible assignment. Even if you just need a break from that frequent flyer, or it's a stretch of three shifts and you can't stomach the patient in room 5 again, or whatever, let it be known. We put certain patients on rotation on my unit, so even if you have them for a few days, you know you'll be free of them next time you come back.

The attitude from other units doesn't help. First, is there any way of educating the other units about what yours is for? It's not fair to be used as a dumping ground, but I think it's necessary to draw attention to the question, "What will we do differently for this patient?" Other units sometimes perceive it as, "This patient is very demanding, so they need med-psych," but they may become so agitated by the additional rules and policies that it's not worth it.

Is there anywhere in the hospital that you have enjoyed floating to in the past? Or another area you'd like to try out? See if you can arrange a share day and whether it's something you can stomach until the end of your contract.

Your mental health comes first. Only you know when you've had enough and it's worth breaking your contract. You can definitely reach that point, though. These units are really interesting, but they are hard to work on. It doesn't help when your manager buys you pizza as a stand-in for truly supporting the staff. Good luck in deciding what to do.

[dhbrn]

On 4/8/2019 at 8:32 AM, ruby_jane said:

Good news: 4 months to go before you get the magic "12 months of experience."

Is there any other floor you can change to? What happens if you break the contract? Sometimes mental health is worth more than money. But stay for a year. Hang in there.

This is great advice.

Only you can decide whether to stick out your full contract. Points of consideration that come to mind are being able to swing paying the penalty charge, and whether you’d need/want to work for this particular hospital/system in the future as most broken contracts=do not rehire.

That being said, I know plenty of people who have left floors like this, broken contract and all, and never looked back. They are ALL healthier and happier today.

Regardless of your decision, please keep reaching out and getting support. You are not alone. You will find your place to thrive in nursing and be such a strong nurse for what you have already accomplished and conquered.

[Idiosyncratic, BSN, RN]

Oh dear do I feel you, do I feel you so much. Although I'm in a different world, I always get the heavier loads(many other nurses have made the comment, and even make jokes about not wanting to work with me cause things always go wrong.), and our ratios are difficult with the acuity.

The only thing I can say, is mental health is more important than a paycheck. It's not worth your sanity. No job is. Your health always matters.

Wish I had more advice, but at this point....I'm working through the same thing.

Keep tough!