Nurse burnout/Moral distress/Compassion fatigue

[Lee238]

I've only been working a few years and am already experiencing signs of burnout/fatigue. There is possibly another word for it that I've recently discovered on here - moral distress (google).

I work on an acute-care floor where the patients cannot do anything for themselves. The management is terrible and extremely uninvolved. I am scared to get into specifics, but i'll just say this: the turnover rate is amazingly high. There are issues with disrespect between the nurses and also across disciplines between nurses and techs. I'm on the nightshift, so it's hard to say if my symptoms are attributed to that, the work environment or a combination of both. I feel it's the latter.

My symptoms:

*Physical exhaustion/fatigue mixed, ironically, with insomnia.

I am constantly tired and lacking energy, yet cannot seem to sleep more than 3-4 hours in a row. I've worked many a 12 hour shifts off 3 hours of sleep, and being on night shifts makes it seem impossible to ever catch up. I lay in bed literally for hours and hours unable to fall asleep and "turn off" my brain and my thoughts, which always, no matter how hard I fight it, go back to work scenarios that fill me with bad feelings that make my stomach turn. Even when I enter the half awake/half asleep phase - I catch myself thinking nonsensical thoughts about work and it wakes me right back up.

*Compassion fatigue

This is so difficult to admit, but if I don't I'll never know if anyone else experiences this. I find my attitude towards patients increasingly negative. I am often times angry inside at them for requesting something from me that I find unnecessary and feel more like a servant than a caregiver. My interactions are brief and impersonal and I get antsy when a lengthy conversation is initiated, all the while thinking about the 7 other patients I have yet to see and the hours of documentation I have yet to do related to being short-staffed. This is scary for me because I am an extremely empathetic person - the thought of a patient outside of work can instantly bring me to tears, thinking of their sickness.

*Troubles with personal/romantic relationships

I find that I am increasingly distant from my boyfriend, who I've lived with for a long time. Often times the things I see at work between the disrespect among coworkers and the degree of sickness my patients have make it impossible for me to open up to him. In other words - the things I see at work are so hard for anyone NOT in the nursing field to relate to that they would find it unimaginable - so I don't even bother getting into it. Instead, I keep it inside, bottled up. I become numb to it myself, like I'm just drifting through life not feeling much. I am even less physically able to be with him - often times freezing up right before we have sex.

*Easily irritable (Basically, a constant state of the worst PMS imaginable).

Anything and everything irritates me and my anger is unproportionate to the "offense". I have zero tolerance for people now (new, I was never like this before). Someone messing up my order at a deli could throw me off for an entire morning. I'm usually a passive aggressive person, but I've found myself so irritable lately that I'm unnecessarily rude.

*Sad

I feel sad - which for me manifests as lazy. I don't want to do anything. I'd rather watch television and tune out than go to the gym and be active and interact with people. I don't even get together with friends that often anymore. It's too much effort.

So there you have it, my brutally honest story of the beginning of my nursing career. It's obvious I am experiencing ALL of those things (burnout, compassion fatigue, and moral distress). Please tell me someone out there relates on this level and help me figure out what steps to take.

[Chin up]

It's called depression. Go see a doctor. Will reply later, after work. Peace!

[SitcomNurse, BSN, MSN, EdD, RN]

first i will say...i am very sorry for your circumstances.

next, you need to evaluate the place you work, and see if it is really where you want to be.

most people think they can endure and overcome acrid work enviornments. even change something about them. but unless you get into administration, you cant change that, sometimes not even then.

take a good look at the letter you wrote, would you want your mother, sister, friend or daughter(future thoughts) .. your boyfriend or your dog to be in this enviornment .....feeling this way?

no?

then why are you?

i have told people hoping to inspire change within them(and for a few it works)

people are exactly where they want to be in life. if they weren't, they would work to change it.that means, you want the things you have, otherwise you'd change it.

look for an opening, re-evaluate your assets and jump on the next train out of that department. it may not come right away, it may be a few months, but for your health, your relationship, and for the good nurse that is inside you, you need to get out.

knowing there is a light at the end of the tunnel that is not a train speeding towards you can often lighten your feelings of sadness and burn out.

save yourself. you wont have anything if you dont.

and yes, i can see those feelings and recognize some of them in myself. i changed what i was doing, went in a totally different direction, even switched shifts. 3 years later i was back on my feet, ready to run, and motivated again. now i am advancing myself and cant see an end to the good things that will come my way.

good luck.

[Elvish, BSN, DNP, RN, NP]

I was where you are when I first started nursing; I could have written that very post. You do sound depressed; whether that's related to neurochemical imbalance from nights, from your work environment, or a combination, is hard to tell. But please get help. Go see your doctor and tell him/her what you've told us. Does your employer have Employee Assistance Programs (EAP)? If so, make use of them. They are free and they are good. I had to do it when I was where you are.

I had to get off nightshift, off that floor fulltime, and away from those coworkers. I started a job at a community health center that was better hours (took a huge pay cut to do it but it saved my sanity). I did stay at the old place on a PRN basis, but found it much more doable when I only had to do it 4 hours at a time and only when I wanted to.

What you change to get better may not be the same as what I had to change. Please do something, though. You can't keep this up for long. My best wishes and a hug are with you.

[chicookie, BSN, RN]

If there is one thing that my parents have taught me is that life is too short to be miserable. I would leave that job ASAP. Its not going to be easy but you can do it!

You would be amazed at what a difference a new work environment can do for you. I was in the same boat as you for a while. I didn't want to talk to anyone, see anyone, think about anything. I was so depressed and miserable. It got to the point where the day that I quit, I came home and my mom said she hadn't seen me smile like that in months. My friends (and my neighbor that I don't even interact with) told me I wasn't the same person. I still sometimes find myself reacting that way when things get bad. Its a hard cycle to stop but you will get there.

I believe you will see this through and I am sure there are alot of people that feel the way I do.

[Darkfield]

Not all places are that terrible! You might feel bad for leaving, but if it is for your own sanity, do it. Go somewhere else, and switch to days. Having no circadian rhythm is a killer.

I know what you mean about being irritated when someone starts up a long conversation. If you have things to do, you have things to do. You can't get them done if you have to sit around and be therapeutic.

[gr8rnpjt, RN]

If you are a caffiene junkie, (coffee, OR tea, OR caffeinated soft drinks) I would suggest you stop the caffiene right away. Nothing interferes more with a good nights(days) sleep than too much caffiene. Even if it never bothered you before, it could become a problem at any time. Your description of your sleep patterns are exactly what I went through when I worked nights. I quit drinking coffee, and developed a rebound headache. Instead of working through the rebound, I turned to medication which in my case was Fiorocet, which contains caffiene. Once I quit ALL caffiene products and worked through the rebound headaches, I finally was able to sleep again.

[taalyn_1, CNA]

Im sorry you are going through this. I would guess that a lot of the problems stem from working midnights. Seriously, if you aren't a nightowl, your interrupted sleep patterns can cause all kinds of mental stress. Cut out the caffiene, try melatonin supplements. Ive been using melatonin lately and it really helps me get the sleep i need. Also, make yourself get up off the sofa and do something fun.. outside. I have to make myself do that too when I get down and just burntout. Its not easy, but you are the "master of your domain" to steal a line from seinfield.

If these types of things aren't helpful maybe changing jobs wouldnt be such a bad idea. In today's economy changing jobs can be scarey, and may take awhile to find a good one, but if thats what it takes to keep your sanity, you may just have to bite the bullet and do it.

Good luck though, and try the no caffiene and melatonin, it may just be as simple as that.

[tewdles, RN]

You are experiencing this in large part because you work for bad management.

My recommendations...

-get help for yourself (eat better, get more exercise, visit your MD, EAP, counselling), whatever it takes to keep you happy and healthy in your profession and career.

-change jobs, you will not be able to escape the failures of your current management team unless you escape their area of influence and practice.

-talk to your significant other. He may not understand the nuances of your job but he loves and is interested in you and your successes, needs, and struggles.

Good luck.

[sourapril]

Your health is your number one priority, not your patients, not your bf. Change your job!

[Katie5]

You're disillusioned.

Your troubles have peaked. I'm never one to advocate leaving a job without further actions. You need to step away from the situation causing this and reevaluate.

Mental/Emotional pain is the worst kind- it stays with you everywhere you go, untilyou take a stand and say enough.

Consider your value system- what is most precious to you? Be totally honest with yourself and go from there.

[Sherriblu]

Your body and mind are telling you you need to find a different job, the beauty of nursing is when you burn out in one area you can go to something totally different and be refreshed. Dont suffer anymore, make the changes you need to be happy. All nurses can go thru this!!