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. :'(

[Txldy]

You all know as well as I do that that kind of turnover is the direct result of bad management.

My advice to you is, get out. As fast as you can.

[Larry3373]

I get how you feel, because I experienced something similar with my first job. Fast forward 3 1/2 years later and I've been working ICU now for about a year and a half. I would never go back to working the floor unless I absolutely had to for survival reasons. I appreciate that ICU patients can be extremely busy with multiple gtts, but I still feel that it is far better than working the floor. I will say that the disadvantage of leaving too soon is that if you wanted to go to ED, ICU, or some other specialty, you may have to start over if you go to another hospital. You can either apply for a specialty at another hospital now, which will help you avoid having 6 or more patients, or stick it out another 6 months and see if you can transfer. I would also like to add that the nurses on your unit that "seem" to be able to handle the workload and appear to be doing fine, may really not be. Haven't you read on here how some nurses chart lies, or don't even put a stethoscope to their patients' chest to do a good physical assessment. I have seen this over and over again. People who on the surface may appear to have good time management are not really doing what they are supposed to be doing. So don't feel bad or feel incompetent. They may be better at hiding their lack of skill or efficiency than you are. I really believe that the reason management and hospital administration get away with increasing our workload so much and creating unsafe working conditions is in part due to the nurses who "act" like they are fine with the workload and expectations. In reality, many of them are not doing what they are required to do by management, but they chart like they do. So don't stress about your situation. Prioritize your care and put patient safety first. I wish you the best!

[Kooky Korky, BSN, RN]

Part of me says to stay and master things, part of me says it's not worth it, but you are unable to get another job right now,, so, you probably need the income.

Can you get off of Nights? Do you want to? That's likely a big issue - messed up sleep.

I used to see other staff sleeping or out smoking and wonder why I always got off late and never had a break except for toilet. I learned that they weren't charting! I knew I wasn't that much slower. Also, they would never call a doctor for anything - cough med, pain med, HTN or low b/p, nothing. I was the one who called docs, processed new orders, restocked med cart and treatment cart, ran to pharmacy for missing meds.

Your floor sounds really rough - Psych, heavy drips, etc.

Are the aides doing their jobs?

I can't decide for you, but do wish you all the best.

[nursecatRN]

I have started applying elsewhere, but there are only a few major systems in the city. Just filled out another application elsewhere that I will print on my next day off in a few days. I am not happy in the job. I am a good nurse. I try to be very safe and care deeply. I don't want to drain myself at a job that doesn't care about me or patients. I will stay where I am until I find something else. I am not so green that I didn't already know how healthcare is but the fact of the matter is that I know I should not have to feel like I want to cry whenever I have to go to work. The work life balance, I thought, would be better on 12's, but it is not because of nights. I do not want to go to days on this job, though I would be open to days in general. I guess we will see in time. I appreciate you all so much. I am so happy I am not alone. I hopefully will not need antidepressant medication because I feel like that is extreme but I will talk to my doctor, maybe take up a yoga class as that helped me with the stress of my first year in nursing stress (which was different than now...) Thank you all again.

[FurBabyMom, MSN, RN]

Oh boy. Your job sounds like my first floor job (and really, like my second patient-wise, but our teamwork was awesome) except our patients were more neuro focused than dialysis/renal. We had tele beds so we got a variety of everything, and could take CPAP, BiPAP, chronic vents, trachs, drips that no other floors (outside of ICUs) could take. We were understaffed, in a big time way. I will say, somewhere around 8 months, things got much more manageable.

For many reasons I left the system I was in for my second job and that region geographically, and moved elsewhere for the job I have now. I recognize that this solution may not be a feasible solution for everyone...but I've been with my current employer >3 years now. I've swapped from the floor to the OR, and it's a night and day difference. I don't get nauseous before work, I have learned so much and grown so much. I face situations much worse than what I ever saw on the floor but our teamwork is a million times better!

I am sure you will find a place in acute care that "fits" you. It may not even be that stepdown/med-surg isn't for you...it may be reflective of the unit (staffing, turnover, etc). I know when I worked the floor, I was floated several times and the other comparable acuity unit I was sent to was FAR better - and it was the teamwork, and people. Not the patients being less sick or "easier" but that the culture of the unit was just better and people treated each other better.

It's not easy or fun getting there but when you find your niche, most days it won't feel like work. :) Trust me, I've been there.

[Larry3373]

To the OP. Did you notice how many people have shared a common experience with you. The common theme here IMO is floor nursing. In states that do not have mandatory nurse patients ratios (all except CA as far as I know), it is so easy to end up with 6 or more patients. Acuity of the patients (and overall neediness) should also be taken into account, but in many cases it is not. Therefore, my solution is to get out of floor nursing and go into a specialty like ER, ICU, OR, PACU, cath lab, L and D, special procedures, etc. the workload in many cases is more manageable and the environment more controlled. For example, in icu, my patients may be confused, very critically I'll, and busy; I only have 2 patients though. Also all my patients are on the monitor and I will usually know immediately if there is a problem. In many cases my patients are sedated on the ventilator. What does that mean? No call lights! When I worked with cath lab patients it was so routine. Pull the sheath, achieve hemostasis, and send them home or to the floor (so you can deal with them after that, just kidding). So I think that if you can, do your time as it were on the floor, then transfer to a specialty area.

[FurBabyMom, MSN, RN]

To the OP. Did you notice how many people have shared a common experience with you. The common theme here IMO is floor nursing. In states that do not have mandatory nurse patients ratios (all except CA as far as I know), it is so easy to end up with 6 or more patients. Acuity of the patients (and overall neediness) should also be taken into account, but in many cases it is not. Therefore, my solution is to get out of floor nursing and go into a specialty like ER, ICU, OR, PACU, cath lab, L and D, special procedures, etc. the workload in many cases is more manageable and the environment more controlled. For example, in icu, my patients may be confused, very critically I'll, and busy; I only have 2 patients though. Also all my patients are on the monitor and I will usually know immediately if there is a problem. In many cases my patients are sedated on the ventilator. What does that mean? No call lights! When I worked with cath lab patients it was so routine. Pull the sheath, achieve hemostasis, and send them home or to the floor (so you can deal with them after that, just kidding). So I think that if you can, do your time as it were on the floor, then transfer to a specialty area.

SO true!

I can have one case all day (I'm scheduled 10 hours most days). Some cases are expected to go 12-18 hours. Other cases are even in the 20+ hours range. My assignment can be elective or emergent case(s). Depending on the severity of an emergency is whether we omit some of our rules (site markings before arrival in OR, waiting for an attending to be present before incision). My charting, in the OR, on average, per patient takes about 30-40 minutes of uninterrupted time. I have PLENTY of time. On a day I have short cases, I *MAY* have 5 patients that day, commonly it's 1-2, MAYBE 3 cases/patients per day.

I will also say, emotionally, work is easier to handle now. I see patients more critically sick, and commonly with really bad problems. My role is more defined - there is an established end of my involvement (patient goes to PACU, or ICU). I help care for patients during (and sometimes after if we're stuck recovering in the OR on PACU hold or hold for an ICU bed) procedures. I have 5-10 minutes to get the patient and their family to trust me, care for a patient for up to 10 hours, and move on. When I go home, it's commonly the end for me. Do we have some repeats or frequent fliers? Yes. Sometimes I'm assigned to them multiple times, others, I'm not. I don't learn who's who in someone's family, I don't hear the life story, I don't bond with patients/families the same way I did as a floor/stepdown nurse. The floor I was on, we often got patients transferred in for seizures with brain mass on CT, they would be on our unit a day or two, go to the OR, hang in ICU for 24-72 hours, and back to our unit with a diagnosis like GBM, and patients/families would be making decisions like treatment vs no treatment, and coming to terms with how much the situation sucked. That was harder than being involved in surgeries with really sick patients with poor prognoses (I can say I did my part in helping to "try everything" if that is what patients/families want).

Seriously, maybe hang out for as long as you can and find somewhere else. Ask to shadow in the OR or somewhere else procedure like.

[Txldy]

So many HR departments here in Texas treat nurses like so much disposable trash.

[ThePrincessBride, MSN, RN, NP]

Unfortunately, this is a very typical scenario: new grad/newish nurse receives minimal orientation and then is set loose with a full pt. load of six to seven with very little support or guidance from other staff.

Some people will say to stick it out for a full year, but OP, what are your long-term goals? Do you want to stay in acute care? If yes, I would try to stick this job out for a little while longer. If not, don't hesitate to look at community/public health jobs (i.e. clinic and school nursing). Life is too short to be stressed and upset all the time!

[idialyze, BSN, RN]

I worked in the hospital as a tech while in nursing school and ending up working the same Telemetry unit for a total of 11 years, left in 1992( yeah I'm a Real Old Crusty Bat!) Worked for a crazy doctor for a year, got divorced and moved to a large city in Alabama, started Agency Nursing. Went to work at a For Profit hospital, and crawled out of there on my knees after 2 years. Patient acuity was getting worse, numbers were growing, and the hospital started laying off housekeeping and lab techs, expecting nurses to pick up the slack.

I was the Charge Nurse for a 48 bed step-down unit, was usually responsible for 10 Heparin Drips with Sliding Scale APPTs, all drawn by myself. I decided to become a vet tech, I was so burned out from taking care of humans!

After about a month my husband insisted I find a job, so I applied to a Outpatient Hemodialysis Unit run by a Large Hospital System.

I fell in love and have not worked in a hospital since, except for a few Acute positions during the 4 years I was a travel Nurse, I have worked in an Outpatient Clinic for 22 years.

I would have to be starving to want to go back to the hospital in any way. I salute people who thrive in the hospital environment, but I know where I want to be for the rest of my Nursing Years!

[Bello75]

Life is too short to be miserable when it can be helped. If the job is too much for you, start looking for work elsewhere. When you get another job then put in your notice. You may not want a target on your back but why work somewhere where you can not ask for help? How will your boss, manager, etc.., know you are having difficulties if you can not freely express that. That is what they are there for, to go to when necessary. Talking to the other nurses about it will get you nowhere. Nursing is a hard job, we all understand that and there are many employers who put too many tasks on one person. Sometimes it's just too much. I think it's great that you got 5 weeks of orientation, I got 5 days! I sincerely hope things get better for you. Talk to your supervisor and see what can be done. You worked hard for your license, don't let any job put you in a position to lose it. You have to be an advocate for yourself because no one else will. Don't suffer in silence and start looking for a job that better suits your needs. You can always keep your current job PRN. Good luck to you, hope things get better.

[Iknowwha2du]

Feeling overwhelmed doesn't just come with being a new nurse because even the older nurses I work with feel this. Feel it and figure out what to do with it because you can't allow it to cause you to not be able to do your job.