New grad burnout

[Nurse12390, BSN]

Hi! This is my first post so bare with me

I’m a new grad nurse who has been working on a busy/understaffed Medsurg/Nephrology/ Transplant floor for a little over 5 months. I worked as a CNA in a level 2 NICU for a year before this job and loved it I really want to work in the NICU or ICU but I was told you need at least 2 years of medsurg experience before you qualify for that kind of position. I am more than willing to put in the time and do whatever it takes to be considered for a position on either of those units. I knew going into medsurg that I wasn’t going to love it but it is a great place to start to build upon my nursing skills.

I love nursing and I have learned a lot on the current floor that I am on. Over the past couple of months however I’ve started to feel really burnt out. My coworkers would describe me as positive, caring and someone who is always willing to help help her coworkers and patients. Lately though I find myself just feeling exhausted and experiencing emotional burnout towards my patients and others.

I’m always willing to help others when they are drowning but I find that I never get that in return. Management has started to float me to other units with little to no support even though as a new grad I’m not supposed to be floated unless I’ve been an RN for a year. Recently I’ve been floated to a unit where I was assigned to a patient who was homeless schizophrenic/aggressive/ IVDU with a large spinal abscess. He constantly tried to climb out of bed and I was told her couldn’t have a sitter because we were understaffed so I was to be his sitter. I was also assigned to 4 other acutely Ill patients who needed constant attention as well. I couldn’t leave the other patients room because it was a safety risk and there was no CNA so I also took on all those responsibilities. He became unresponsive at one point in the night because he had been stashing methadone in his room and had been taking it in addition to all the other narcotics and benzos I had been giving him for his withdawl symptoms and pain management. He continued to have these unresponsive events through out the nights that I took care of him and I had little to no support from other nurses on the floor or the doctors (who wanted to wait for the day shift team before intervening or changing orders). It was a very unsafe situation for all the patients I was taking care of. I felt like I wasn’t able to care for my other patients the way I normally do. I had little to no time to look through my other patient’s charts and complete my med passes. I ended up staying two hours late every day to chart. I usually have all my charting done on time so this has been especially frustrating. I usually give good reports and I understand my patients really well but since I haven’t had the time to write stuff down I end up giving the bare minimum to the nurses taking over. I’ve had nurses yell at me and chew me out during report. I even had one who walked away midway through report and complain to another nurse while I was sitting next to her that I didn’t know when the patients LBM was while rolling her eyes at me.

Unfortunately for the last two months this has been how most of my assignments go and I’m starting to feel really burnt out. We have a lot of homeless/ IVDU on my floor currently so I spend most of my shift being screamed at by them. I genuinely try to connect with them and help but I always end up being verbally abused by them or having them tell other staff members that I am neglecting them because their pain mediation is 5 minutes late.

my nurse manager has also been making mistakes in my schedule. For example I picked up a shift to try and help out and I was scheduled to work from 7p-11:30p. I work night shift so working another shift after this one isn’t a big deal. My nurse manager scheduled me to work 7a-7p the next day. When I emailed her about it she basically told me to suck it up. I didn’t get out of work till 1am and I am expected to work at 7am the same day. These schedule mistakes are very common and sometimes I end up working 4-5 12 hour shifts in a row with the same acute patient assignment. I hate complaining and I usually never complain. I’ve really tried to make the most of my current situation. I hate feeling this burnt out when I am only 5 months into my nursing career. it makes me feel like a terrible nurse.

I also feel like I’m not really making a difference in the lives of my patients. I feel more like a vending machine pumping out medications which is not the nurse I want to be. I feel bad delegating task to my CNAs who are swamped and overworked so I usually don’t. I also feel bad not being able to do everything that my patients ask for and feel like I’m letting them down. I really want to help my patient and I’m looking for suggestions on how to feel less burnt out so that I can be the best nurse I can be.

Thanks for reading and sorry for the long rant! ?

[JKL33]

Whoa. Well after reading your first couple of paragraphs I was about to provide some encouragement about how you are going through a huge adjustment and are processing the gravity of your professional role and it'll all be okay...blah, blah, blah....then this:

4 hours ago, Ashywlms1290 said:

Recently I’ve been floated to a unit where I was assigned to a patient who was homeless schizophrenic/aggressive/ IVDU with a large spinal abscess. He constantly tried to climb out of bed and I was told her couldn’t have a sitter because we were understaffed so I was to be his sitter. I was also assigned to 4 other acutely Ill patients who needed constant attention as well.

?

That is when you call the supervisor. Keep calling people until someone helps. If they won't come help you then call the next person, even if it means calling someone important at home.

Call the provider, tell them you need someone to come and evaluate the patient in person. If they say this insane malarkey about wanting to wait for day shift to change the plan of care, you say, "That is unacceptable. If you can't help me I need to call someone else." Say it and mean it.

Call the supervisor, tell them you need them to come to the room. If they say they can't or they say something insane like "you'll have to be the sitter" then you say "That is unacceptable. If you can't help me I need to call someone else."

[File incident report, of course, at some point before you go home.]

You *MUST* put your foot down hard on things like this. No one can be a sitter while in charge of a full patient assignment. To whomever says that, you immediately say that is unacceptable and start making other calls. Never acquiesce to what you know is a dangerous situation where you cannot provide any standard of nursing care.

The next thing is that you meet with your manager and tell them that can never happen again.

The rest of it with your schedule is just more abuse...for now don't pick up any more extra shifts. Don't answer your phone and if they ask you in person just say no. Don't make excuses.

Start looking for another job.

This meets both of my tests for when not to stay somewhere 1) unsafe 2) management effing with people and totally abusive.

I'm sorry you are in this position.

And for F sake, YOU ARE NOT "BURNED OUT."

[EDNURSE20, BSN]

It’s common when you are new employee to get taken advantage of, because most people don’t want to rock the boat. But in nursing you have to stick up for your self. You have to have the courage to stand up and say this is not safe! I won’t accept this. Usually employers back off. But it is tough.

[speedynurse, ADN, BSN, RN, EMT-P]

This is not a typical new grad problem or even a typical unit problem. I am not saying that every unit or job doesn’t have problems - generally it does. But yours sounds like an impossible situation for any nurse....between the nurse to patient ratio, disorganized staffing, possibly some nurse bullying, type of patients, etc. Most healthcare systems will offer a transfer at 6 months. If not, then try other healthcare systems. Apply for NICU or ICU jobs - but maybe also apply for step down units, ER, nursery, etc. There are so many other nursing specialities that can build that bridge to critical care nursing of your choice and not be as overwhelming as your situation. I agree with others - you are not burned out. You are in a very poor situation and frustrated with it. Other nurses have left jobs within just a few months for similar reasons or even lesser reasons.

[Green Tea, RN]

You may not wanna hear this, but one of the things I learned when I was working as a nurse was do not help other people to seek something in return. Why? Because it is disappointing or even you may feel it is betrayal when you cannot receive something expected. Pick up a shift only if you need extra money. Help other nurses only if you have extra time and you wanna kill it. It may sound cold, but after all some people will never appreciate no matter what you do.

[Nurse12390, BSN]

Thanks everyone for all the great advise! I definitely think one of my biggest weakness is not being assertive enough. As a new grad I don’t want to “rock the boat” or say no to helping others. I have gotten better at putting my foot down but there are a lot of unmotivated/overworked CNAs on my floor who really push back or give me attitude for delegating tasks to them (which I rarely do). A lot of the times I just end up doing things myself because it easier than having to track someone down and hold them accountable for doing something or dealing with their push back. There are a couple of wonderful CNAs on my floor that I love working with but unfortunately I don’t get to work with them enough. I do feel like my assignments tend to be more acute or with very behaviorally challenging patients than my peers. Other people have brought it up to me as well. I’m not really sure why my assignments have been heavier with little to no help in the past couple of months. Others have said it’s because I never complain but sometimes it just feel like charge doesn’t like me.

The homeless IVDU patient that I had for two nights ended up going to IMC. I did try both of those nights to advocate for how unsafe this situation was to charge and the providers but I received a lot of push back/dismissal. Charge told me that if I get a sitter then we would have to float a nurse and all the nurse assignments would go up to 6 patients including mine. I called charge all night and the providers with my concerns about the patient but it was like pulling teeth to get them to come and assess him. It took charge 40 minutes to come into the room during one of his unresponsive events and the provider told me that he was too busy to come (ended up coming later in the night and not doing anything). I did tell him that someone else needs to come then because this is a drastic change in this patient’s clinical picture and that Im worried that he is heading towards a rapid responsive event. I think because this man was homeless with a drug/mental health problem he was written off a lot and not given the care he really needed which broke my heart as his nurse. Another thing that I’ve noticed is people just start to assume that this is a patients baseline when it actually isn’t which was also happening to him a lot.

Looking back I definitely should have escalated my concerns up the chain of command. The primary person that was covering that patient that night was a new resident so I should have voiced my concerns to someone else higher up on the chain. I also should have done the same thing with the charge nurse. It’s hard for me as a new grad because when I get this kind of push back I just assume that maybe I’m overreacting. But In this case I knew how unsafe it was and I was very frustrated that I was getting so much push back when clearly something was very wrong.

I did email my nurse manager and asked her moving forward if I could just stick to my agreed upon 3 12 hour night shifts. I haven’t gotten a response back yet but moving forward I’m definitely going to put my foot down with being preassigned to other units/extra shifts without being asked or told.

I started applying to other positions and reached out to HR to inquire more about the steps I need to take to transfer to another unit since I am past the 6 month mark.

This is all been very hard on me. It reassuring to hear that other don’t feel that I’m burnt out because I was really worried that I was. I am a very happy person who loves to help others so being on a floor that doesn’t foster team work has been frustrating to me. It will be difficult for me to set boundaries and only help other if I have the time but I know I need to make that change moving forward.

I still worry that how exhausted I’m feeling right now so soon into my nursing career is a sign that it isn’t for me or that I’m not cut out for it. I really do love working in the medical field and helping other but the last two months make me question If I am even a good nurse.

Thanks again for taking the time to read my long post and providing such great feed back. I really appreciate it!

[JKL33]

5 hours ago, Ashywlms1290 said:

The homeless IVDU patient that I had for two nights ended up going to IMC. I did try both of those nights to advocate for how unsafe this situation was to charge and the providers but I received a lot of push back/dismissal. Charge told me that if I get a sitter then we would have to float a nurse and all the nurse assignments would go up to 6 patients including mine.

It does sound like they are willing to have you struggle with being overly-burdened. You'll have to call some bluffs and put your foot down and be persistent and very straightforward.

In the scenario you described, everyone having 6 patients that they can sort-of keep a handle on is better than everyone having 5 and you not being able to manage any of yours due to a situation that needed a sitter. So the response to charge would've been: "Okay, let's do that, then." Maybe it would've happened, or just maybe, when other people have to share the burden, someone will come up with an even better plan. But no one will care or do jack squat if they know that you will absorb it all.

5 hours ago, Ashywlms1290 said:

I did tell him that someone else needs to come then because this is a drastic change in this patient’s clinical picture and that Im worried that he is heading towards a rapid responsive event.

Alternative would have been to just call the RR to begin with. A patient who is acutely unresponsive is a legit situation for RRT.

5 hours ago, Ashywlms1290 said:

Looking back I definitely should have escalated my concerns up the chain of command. The primary person that was covering that patient that night was a new resident so I should have voiced my concerns to someone else higher up on the chain.

Yes. Have your information ready, make sure it is concise and gives a clear representation of the situation. If the resident is reluctant and/or doesn't really have much to say and can't/won't come and assess the patient (and especially if they are expressing something like not really wanting to do anything til morning) then just kindly ask if it would be better for you to call [name of their supervising resident], reiterating that you need someone.

5 hours ago, Ashywlms1290 said:

I did email my nurse manager and asked her moving forward if I could just stick to my agreed upon 3 12 hour night shifts.

Is everyone doing mandatory OT right now? If so, that should only be temporary, not a long-term way to staff the unit. But everyone isn't doing mandatory OT right now due to some acute need and it's just you who is being pre-scheduled for OT, then this ^ is a "tell," not an "ask." As in, "Please only schedule me for my agreed-upon 36 hours per week. Thank you." Or, "I am not available to work OT shifts at this time. Thank you."

5 hours ago, Ashywlms1290 said:

This is all been very hard on me. It reassuring to hear that other don’t feel that I’m burnt out because I was really worried that I was. I am a very happy person who loves to help others [...]

This is why I hate this term burn-out as it is commonly used. My opinion is that it is wrong the way we are calling people burned out and making them feel as if something is individually wrong with them just because they start to become mentally and emotionally fatigued due solely to poor treatment or poor circumstances that are out of their control. These are problems with the system--not personal defects in tens of thousands of individual healthcare providers.

Don't think of yourself as burned out. You are learning a lesson here and growing stronger. There is nothing wrong with you. Your post reflects that you seem to be operating in a manner consistent with anyone else at the beginner stage of a nursing career.

5 hours ago, Ashywlms1290 said:

I still worry that how exhausted I’m feeling right now so soon into my nursing career is a sign that it isn’t for me or that I’m not cut out for it.

Straightforward info here: You do have to get stronger in advocating for yourself and your patients. It's super tricky at first because, as you noted, it's hard to know if your assessments are on point when you're a novice/beginner. And they might not be--but that's the nature of being a novice. You have to accept that this is a process, and others do too.

Stick with basic principles when you're concerned about a patient scenario. For example, in the case you described the "basic" is that the guy went unresponsive and could not be aroused. End of story. Call an RRT.

It isn't going to be comfortable or pretty to get used to being a stronger advocate. I'll tell you right now that you will overreact or make mistakes or fail to assess the situation completely. Just accept that this is going to happen. You might call an RR and then find out that the situation wasn't as dire as you thought. But...guess what. If others can't or won't help you assess the situation, then you have to use the resources that are available.

You will learn quickly. Advocating and then having to back off a little is better than not advocating and having absolute chaos and possible patient harm.

I think you should take on this challenge of learning to speak up for yourself and your patients. Be positive about it, not afraid. You can do it. ???

[9kidsmomRN]

On 8/15/2020 at 1:25 AM, Ashywlms1290 said:

do feel like my assignments tend to be more acute or with very behaviorally challenging patients than my peers. Other people have brought it up to me as well. I’m not really sure why my assignments have been heavier with little to no help in the past couple of months. Others have said it’s because I never complain

When I changed jobs something similar happened to me. I was a “nice person” and didn’t complain. I always got the ETOH withdrawals, difficult family situations, the abusive patients. Finally I said “enough! Why don’t the rest of the staff have to take these pts?” The answer: “you handle them so well “. I said “everyone else gets paid to handle these pts too. Spread the wealth! Everyone needs to take their turn caring for the difficult patients.” I had to stand up for myself—no one else would! Unfortunately caring nurses don’t seem to take care of each other. ?

[OUxPhys, BSN, RN]

You learn real quick who to help and who not to waste your time with. It sounds cold but it's true. Don't let people walk over you. Stick up for yourself. If you see you are getting bad assignments say something. If you don't they will keep doing it. Agreed with what other posters said. If you want to pick up extra shifts make sure you do it because you want extra money, not because they are short. If you do that then management will count on you all the time and won't fix the true problem: short staffing.

[Nurse12390, BSN]

Thank you for all the great feedback! I’m still having a really hard time on the floor. A night ago I had a patient who was in a MVA and was extremely confused and trying to get out of bed constantly. He was in a room furthest away from the nursing station. I asked charge if I could get a sitter or move him to a room closer to the nurses station because I was afraid that I wouldn’t be able to get to his room quick enough to prevent a fall if he set off his bed alarm. I was told that there were no available sitters or rooms. Later that night he ended up failing and I felt terrible about it. I asked charge for feedback on how I could’ve prevented this and she didn’t really respond. She told me that she will make sure he is moved closer to the nurses station or will have a sitter from now on. I come in last night and he is still in the same room without a sitter. Within an hour into my shift he was trying to get out of bed again. I again asked charge if he could be moved to a closer room or if I could have a sitter because he already fell last night and I’m very worried about his safety. Again I was told that there was no available rooms or staffing but I could sit in the room with him. I had four other patients I was assigned to as well as being this patients sitter. I was extremely frustrated and feel really bad about being this mad about it. I am consistently having these kind of assignments when the other nurses on my floor are not. When I relayed my frustration I was told that every nurse needs to pitch in from time to time (which I am more than happy to do) but none of the other nurses have had to be their own sitter on the floor with a full patient assignment. I’ve started to notice that recourses/extra help is delighted towards the nurses that charge is friends with.

I still consistently have assignments heavy with behavioral patients (IVDU, SUD or CIWA). I’ve tried to set boundaries when patients who are verbally abusive towards me. I had one patient who was screaming at me and I told him that I was sorry he was so upset but I’m just trying to help him and that I would give him some time to cool off and that I would come back and be more than willing to help him. He rang out for me 10 times in 3 minutes seeking pain meds. I told charge the situation and she basically told me to go back in there. It was the first time I had set a clear boundary with a verbally abusive patient and to not have support from charge was very disappointing.

I also am assigned to work 10 12s this week. It was a mistake and a lot of the shifts I had requested were not finalized until this week. I never intended to work this many shifts I just requested days I could work and usually management will figure out the needs of the unit and put me on for a couple of extra shifts. Charge brought it up with me and said that they have never allowed someone to work this many shifts in a row because it is so unsafe and that management should’ve recognized it was a mistake. Charge encouraged me to reach out and cut back my upcoming hours. When I emailed my manager and apologized for the oversight on my end and asked if there is anyway I could reduce my hours because I felt it was unsafe for me she told me that I was leaving the floor short staffed and that in the future I should have more oversight and fully commitment to the shift I agreed to. I understand completely where she is coming from and do agree that part of this is on me but I never call out or complain and the only reason I did was because I felt it was unsafe for me to work that many hours. She gave me two days off so I am now working 8 12s.

Lastly I took care of my first incarcerated patient this week. In report that I got from charge I was told the reason why she was incarcerated. I was also told multiple times by the warden that was in the room with her. When giving report to the next nurse I relayed this information because I thought I was suppose to. Leaving my shift today I was pulled aside by a CNA (who is aways present during nursing reports) to tell me that the report I had given was extremely inappropriate and unprofessional and I had made her feel very uncomfortable by disclosing this information during report. She told me that she took it upon herself to pull me aside to have this talk with me and if she didn’t the other nurse would have. I told her that I was really sorry and that it was never my intention to make anyone feel this way but that I was just relaying the same report that charge had given me. She told me that this was a good teachable moment for me to grow professionally and learn from my mistakes. Looking back on it I do see where she is coming from and I feel bad disclosing the reason why this individual was incarcerated but I honestly thought that I was supposed to because charge had given me the same report.

I have been so sad leaving my shifts and have even cried in the bathroom at work which is very unlike me. I’m usually a happy person who doesn’t let these kind of things get to me but I feel completely drained and exhausted from these experiences. I find myself questioning if I’m a terrible nurse or if I am unprofessional and shouldn’t be in the nursing field.

I’m feeling completely lost and appreciate any feedback.

[LibraNurse27, BSN, RN]

This job sounds terrible and unsafe. Unsupportive management, unsupportive/unhelpful/unfair charge nurse, unhelpful coworkers. A patient who needs a sitter needs a sitter! If it's not possible to get one quickly, charge has to sit with the pt. And I'm sure it would have been possible to swap the confused pt with an alert pt closer to the nurse station. We do it all the time. Usually the alert pts are happy to be further from our chatting LOL. At the very least if it was truly impossible to get a sitter or a new room, others should be helping out when they hear the bed alarm go off.

Working 8 or 10 12 hr shifts in a row is not safe. Your manager knows that, should not have approved that schedule, and should not guilt trip you about it. For the fall, I would document how you advocated for sitter, room change, etc and were not given help. If charge and manager don't care, go to supervisor, administration, etc. If no one cares, I would quit or transfer to a dept with a reputation for better safety and teamwork.

I know it's hard to find a new job right now, so if you absolutely can't financially quit, keep standing up for yourself, and please don't sign up for any extra shifts if you can avoid it. Your mental and physical health matter.

[Nurse12390, BSN]

Thank you for your feedback. I’ve been applying for jobs but because I only have 8 months of nursing experience not a lot of places are willing to take me. I just feel incredibly sad and all of this has really gotten to me. Im a very happy person and really loved nursing in the beginning. I’m now starting to question if I even am a good nurse or if I am unprofessional. I’m trying to make sense of why this continues to happen. I always try to help others and my patients in anyway I can. I’ve never been in a situation like this and its really eating away at me. I really don’t know how I’m going to work the next 6 nights if this is how it’s going to continue to go.