Overwhelmed at work :(

[nursecatRN]

Hello all. I'm looking for some advice or maybe hints on how to handle my stress at work. I am not a new nurse. I worked for about a year at a LTC SNF, then 3 years in outpatient with case management and low income patients. I have been at the hospital about half a year now and dread going to work every day. I prayed for a hospital job for years but never got one until after I finally finished my BSN. Now I regret taking the job because I am so stressed out and afraid.

I work on a floor where acuity is high. We take PD, HD, non-critical drips like insulin, heparin, dobutamine, CBI, etc. We also take a ton of addiction/active withdrawal patients and tons of psych issues, complicated telemetry patients, and more. We even can take patients on bipap. However, I received 5 weeks of training with 5 preceptors then was left alone on nights with at least 6 patients every night. All of my preceptors have left this unit and moved on as well as at least 20 other staff members on that floor since I came. I fear so much that I will miss something or do something wrong. Any time a patient's IV infiltrates, I get an admission with a bunch of bedsores, or I hear any alarm, I start to have a panic attack inside. This is not normal for me. I clinically feel I am competent but I am overwhelmed with such a high acuity patient load and there's always 10,000 things going on and going wrong. Is there any advice you guys might have to calm down? I want to cry almost all shift every shift. I am afraid I am a bad nurse because some people seem to be just fine. I have been a nurse much longer than some people who are thriving there as well. I am so sad.

I want to leave and go somewhere else but there are not a lot of jobs in this area and I can't transfer to another unit within this system for at least a year. I am depressed recently and don't know if I can do this 6 more months. :'(

[nutella, MSN, RN]

I want to put out that feeling overwhelmed is a normal experience given that you did not work in an environment that was that fast paced with high acuity. It takes some time to get used to the constant multitasking and the work flow. 6 months are just not enough to be comfortable ! Especially when you also deal with drips, telemetry and the general high acuity. I would say from my own experience on tele floors in an academic teaching hospital with your stated patient population that it took me one year to get truly comfortable and two years to find that I was all around well educated and established. There is just so much to learn that it takes time.

Nights can be rough when you do not sleep well during the day and can lead to general unwell being and anxiety.

I think you need to assess if you are able to continue working there. It is normal not to feel happy about work every single day and there are days I am not looking forward to working for a variety of reasons, that is life. Those stretches are normal. Me recommendation is to assess where you are at with your learning in your job and perhaps talk to a mentor or an experienced nurse you trust or an educator to get some feedback on your skills and practice. I found it helpful to have a list with things I had to do so I would not forget anything when busy and also structured my shift as much as possible.

Perhaps you can take some days off for a mini vacation to recharge your batteries.

Assess if you are sleeping well and if not take steps to get that straighten out.

If you are depressed perhaps you want to make an appointment with a mental health professional or PCP to discuss your feelings of depression.

Also, if you are able to stick it out and get through the rough patch you will have much better chances of finding a position after a year of working there. Time flies by fast and another 6 months would go by quickly. In June you could be close to a year and look around or look into a transfer.

If you are not able to stick it out the best is to start applying but hold your job until you find something new because it is much harder to find a job once you are unemployed.

Good luck!

[Farawyn]

I'm sorry.

No one should feel this way. 5 weeks seems to short of an orientation and 6 patients sounds like way too many.

What is the turnover on this floor? Who has been there the longest, and why?

Can you speak to HR?

[nursecatRN]

The person with the highest seniority works only the shifts she wants to on nights. Some people have been there many years but like I said, most people stay a year or so and then transfer off. All of the people I oriented with have left. Over 20 since I started have left. If I were to talk to my manager they probably would just fire me. It's kind of a sink or swim mentality there, and there is a clique of people who go out drinking after shifts together, however I keep to myself mostly and just lightly socialize with them so I've never been invited to any of their get togethers. I am going to try to stick it out but they make my schedule very difficult to relax at all. One night on, one night off, and scheduled to work the night of every holiday (the shift you get no holiday pay on) because of my low seniority probably don't help my unhappiness at the job. Thanks for your advice guys. I appreciate you all.

[nursecatRN]

I think probably most of my stress comes from feeling like it's unsafe to have so many patients. 6-7 high acuity patients is just crazy, I feel. Some people agree, some just say suck it up. I want to do well, take great care of my patients and be attentive, but I am stressed to the limit and can't spend time talking to them or doing anything extra. I can barely assess, pass meds, and finish required tasks. I get a few minutes to eat and one chance to pee in an entire shift if I'm lucky. I didn't think it would be like this.

[Farawyn]

Okay, why do you think you'd get fired if you talk to the manager about your concerns?

I'm just trying to weed through what is anxiety and how it is.

IS she unapproachable?

What about HR?

[Farawyn]

I think probably most of my stress comes from feeling like it's unsafe to have so many patients. 6-7 high acuity patients is just crazy, I feel. Some people agree, some just say suck it up. I want to do well, take great care of my patients and be attentive, but I am stressed to the limit and can't spend time talking to them or doing anything extra. I can barely assess, pass meds, and finish required tasks. I get a few minutes to eat and one chance to pee in an entire shift if I'm lucky. I didn't think it would be like this.

Are people familiar with the floor telling you to suck it up?

[nursecatRN]

The manager is only there some of the times. I actually like when she is there because those are the nights I don't feel overwhelmed usually. I feel like when I ask for help they treat me like I am incompetent though so I am fearful to talk to them. The managers on days are never there really. One of them came in one time and followed me on bedside report and then wrote me and the day shift nurse up because my patient who was in legitimate excruciating pain and who I told day shift hadn't had a minute of sleep all night was sleeping, had their pulse ox and tele monitors stable, and we didn't wake them up for report. They just are out of touch with the reality of patient care as they've all been managers for so long and do no actual bedside nursing. I feel very defeated I guess. No matter what I do there's always something wrong. The night shift manager gave me good reviews, but like I said she doesn't really see when I am struggling because she is there maybe 2 nights a week and I see her maybe 2 nights a month and haven't had nightmare shifts with her there. They staff a little better when management is there too..

[nursecatRN]

There's a couple people who have been there about a year who have, they say "that's just how it is." and 2 of the 3 have left since I've been there for new jobs. So I guess they got their out and didn't care.

[Lev, MSN, RN, NP]

I can understand why a lot of staff are leaving. 6 patients is 2-3 patients too many for a telemetry/step down unit. P.S. insulin and dobutamine are critical drips in most hospitals. 5 weeks training is nothing for someone with no hospital experience. Sounds like you were thrown to the wolves and had an inadequate training. This hospital needs to make some serious improvements if they want to retain staff.

Your concerns are valid. I would still wait and see how you are holding up once you get a year of experience. See how you feel then. If things haven't improved much, by all means follow your former coworkers.

This is totally new for you and it does take about a year to start feeling comfortable. If you feel your anxiety is out of control, please talk to your PCP and get a script for something - even if just in the short term. Getting over the anxious feelings can make your performance much better.

Organize and try to get a semblance of a routine. Knock your assessments out and document them early. You should not be taking more than 5-10 minutes on each assessment. You also assess pain, so when you come back to do meds you can bring them PRN pain meds. The initial assessment is not the time to do wound care. Wound care should be done after giving meds, including pain meds for before you do the dressing changes on a painful wound. After your assessment, print out a rhythm strip and tape it to the chart. Then review your vital signs and give meds (including the pain meds). Once you get your meds in, take a breather and go hide somewhere to document your notes.

At the start of your shift, you will be delegating a lot to the CNA. Tell her what you are doing (i.e. giving meds, in with room 202 doing her assessment) and if she could help room 206 go to the bathroom. The CNAs are there to help with vital signs, toilet patients, and set up meals. If the CNA is available please please ask them to do certain things. Certain CNAs need to be told to do something because if given a choice they will refuse and say they are busy and then you'll see them on their phone or hiding in the corner. For those CNA you need to tell them "Ashley, please help room 206 to the bathroom. Thank you."

When you are with a patient, try to ignore the fact that you have 5 other people to take care of too. This does not mean that you do everything at a leisurely pace and listen to your patient talk about her 10 cats for 20 minutes, but it does kind of help ease the anxiety I've found. When I started doing this at my med-surg job (which I know is easier since these patients are not critically ill) it changed everything for me.

It's also important to coordinate with the CNAs. For example, if you have a patient with wounds tell the CNA to save her bath for later and you will go in together to bathe the patient. That way, the CNA can help with wound care. Remember to continuously tell your CNAs how much you appreciate their help. Also, as soon as you find out that you are getting an admission, tell the CNA a little bit about the patient (like a mini report) and where and when they will be coming.

I hope this is helpful. Hang in there.

[Lev, MSN, RN, NP]

Also, bringing up concerns to your manager and or HR will put a target on your back.

[nursecatRN]

Very, thank you. On good nights when I'm not putting out fires, assessments are quick and I start meds. Sometimes though the wound care has to be done when the patient has a c-diff BM and it's in their horrible bedsores haha.