Pediatric Nursing - STress and Burnout (1)

wells126 · May 2, 2006

It takes a lot of time to address all of the questions, but I believe nurses are leaving the profession due to stress. I am in a PICU where the patients just get sicker and sicker. Unlike threee or four years ago, those patients came along every few months. It seems now as though every time you turn around, there is a new child about to die who you have been charged with saving. It takes its toll, I see younger new nurses who are overwhelmed by the high expectancy of knowledge that a new grad does not have. True love for a profession can only get some people so far for their career.

:spam:

jaka1 · May 2, 2006

hello, I have been doing newborn nursery and ob for the past 12 years in rural AZ. In our facility I think the nursing shortage is due to the lack of effort in retention. The facility does a lot to recruit new grads from the local community college but once they have experience they tend to go to bigger facilities where the pay is much greater. Since we have so many new grads in our facility, the experienced nurses tend to get heavier patient assignments with higher acuities and yet we make only cents more than they do which only adds to our frustration level. I also think nurses are leaving due to stress related to the number and acuity of pts they are required to care for.

nurselittlek · May 2, 2006

you make a good point about the patient load -- i have seen places that focus on a pt to nurse ratio but the acuity levels are ignored -- or the acuity levels are completed to fill a square..... do you think there's any way to get the more experienced nurses the recognition they receive -- more money may not be an option -- is there any other way you think they might feel more appreciated???

nursfrmjmu · May 3, 2006

I am a nurse in gen. peds, which includes heme/onc. We currently have a shortage and this directly increases the stress levels of the nurses I work with and myself. When there is no one there that you can check off chemo with because they're busy with their own patients, it can get very frustrating. Our facility recruits new grads from local nursing schools. They have intermittently offered referral bonuses for experienced RN's as well. Our facility is Magnet and this also brings nurses here as well as the guaranteed nurse to patient ratio. I think that increased stress levels and options of other high paying careers with less stress are 2 reasons that people are leaving the nursing profession. The latter for decreased nursing school applicants. Our facility gives personal recognition for anyone who has been employed here for 5 years. Then every 5 years after that. Those employees and a guest recieve a very nice and fancy dinner at a local resort and recieve a pin and names gets called one by one with the number of years employed here as you walk up to get it! The hospital president and CEO and all of the other administrators are there and participating. I think this is an excellent form of recognition without a raise or monetary compensation.

cubsfan · May 3, 2006

Hello group,

First a little about myself. I have been a NICU nurse for 20 years, the last 9 in Az. I left the bedside 5 years ago to do developmental care in the nursery. I like to say that now I get to do the fun part of what I did before, with less stress.

Now to answer our moderator's questions.

1. Yes, we do have a shortage of nurses.

2. We have an active recruitment and retention committee. They have tried several different programs. Everything seems to work for a short time, but loses its effect very quickly. For example, weekend program, bonuses for so many extra shifts in a given period (usually a 6-week schedule,) reduced holiday commitment for seniority, conference registration for extra shifts, etc. We also hire travelers. They actively monitor the market to keep salaries competitive.

3. Of course, staffing shortages force nurses to prioritize patient needs. Many times the nurses have to choose between priorities, any time that happens he/she will be stressed.

4. Nursing is as glamorous as it was in the 50's and 60's. Let's face it, nursing is primarily a female profession and women today want a career. Back then they were looking for something to tide them over until they got married and could stay home to raise a family. Nursing salary is stagnant, there is very little range in salary for the bedside caregiver. Young women that are looking for careers are not going to go into something that they see as having no economic future and makes them work weekend, nights and holidays. As I am writing this I am wondering, how do we sell it to this me generation?????????

5. They're leaving for many of the same reasons stated in #4, as well as lack of professionalism. No other profession allows people with such a wide range of credentials to practice at the same level for the same salary. We are also a very self-deprecating group. My boss describes this as nurses being like a crab bucket... you never have to put a lid on a bucket of crabs, because if a crab tries to crawl out of the bucket, just as it gets to the top of the bucket the rest of the crabs will drag it back down.

6. I think the emphasis on education and evidence based practice is bringing up the level professionalism, but this is a very slow moving change. I would like to see more nursing autonomy and nurses shown more respect by physicians and management. But I have to put in a caveat here - they have to make sure that they have earned the autonomy and respect. I have seen way too many nurses that think they should be given autonomy that I wouldn't trust with the care of my dog.

Rosey88 · May 3, 2006

Hi all! I work on a general pediatric floor. More specifically infants and toddlers. I have been a nurse for just about 2 years. I don't really notice a shortage of RNs on the unit I work. I think we struggle more with staffing PCTs. I work at a magnet hospital where there is a four to one nurse to pt ratio. Nurses are rarely required to care for more than four pts at a time. However, there will be times when there is only one PCT for 18 pts. It is impossible to start an IV on a toddler alone. As an RN I depend on the assistance PCTs provide. I notice when we are short staffed and it definately can be a source of stress. "Teamwork" is a part of they culture of the unit I work. I have not experienced a night where at least two or three people at different times have said, "Do you need help with anything?"

I am really greatful that our unit has such a great patient care manager who advocates for the staff. We have a good retention rate for RNs on the floor I work. I am not sure all the units in this facility are as lucky. I can think of a few units where the majority of staff is travelers.

I don't think there is a lack of interest in nursing. It can be very tough to gain acceptance to a nursing school. I know the University of Arizona only accepts 50 students a semester.

Nursing is a very demanding profession, both physically and emotionally. I think nurses leave the profession d/t lack of support from management- especially management higher up in the hospital. I could not imagine working in a facility that does not value what we do. I am on a first name basis with most of our pediatric physicians and I think the majority of them appreciate the input nurses provide to pt care.

nurselittlek · May 3, 2006

There have been some great points -- like the idea of a recognition program being in place for length of stay. I think 5 years is a pretty long time to go between each ceremony, but again -- rewards usually equal more money which isn't always available. What about offering a higher amount for continuing education with each chink of time at the facility. Would be nice to receive an conference expense account after spending a certain amount of time at one facility (especially one that increases in direct proportion to experience.)

Would anyone consider becoming a salaried worker? In that situation you'd make the same amount each pay period with possible reimbursement for overtime... Also - does anyone have an on-call system in place or does the facility start calling "the list" if someone calls off? I agree with the idea that nursing needs to be addressed as the profession it is versus a "job..." I wonder how other professionals would handle being called-off or called-on at the last minute...

Calzonan RN · May 3, 2006

I am not a nurse yet, in fact I'm only in my first block of nursing school, but I can tell you a couple of reasons they may have retaining or getting new nurses. Several friends of mine have just completed their clinicals. I also have several friends in higher blocks. ALL of these friends have said that the nurses at the facilities treat them like c*ap, not all of the nurses but enough to make them think about quitting after two years of pre-req's and a semester or two of waiting to get placed and a block or more of nursing school. I've met some nurses though, that are just amazed at how students are treated. They, of course, went to school in another state. One nurse in particular told me that her hospital LOVED student nurses 'cause they were an extra pair of hands and helped to lighten the nurses load. It seems like a lot of the nurses here in Arizona look at students as a burden instead of looking to them for help with patient care.

Also, I have some friends in a certain school here in Phoenix and in block one they've lost at least half of their students. A lot of these students would have made really good nurses, but the tests are either so hard or are so abstract that a lot of them are failing. These are people who have passed all of the pre-req's, PLUS clinicals, PLUS pharm and assessment, but have a 75.5 in process and so will not pass block one.

I've heard from nurses from other states that nurses here are not treated very well by the doctors. Now I"m sure it depends on which hospital you work at, and possibley even which floor, but I've been told in other states that nurses are treated as part of a team by the doctors. That their input is important and listened to, but it's not like that here. Again, this is only the opinion of about four or five nurses I know from other states, but it could be part of the problem that hospitals have with retaining nurses.

nursfrmjmu · May 3, 2006

This sounds crazy! At least at this facility and in pediatrics, precepting new nurses or even experienced nurses is something that we take pride in. We really enjoy students and always try to recruit them either to our unit or pediatrics in general. As for your colleagues who passed everything but process should ask their instructors for support and guidance. In response to nurselittlek, I don't think I could or would ever go to salaried. My manager is salaried and I don't know if there is compensation for that amount of time that she puts in. She helps out the floor and puts her administative duties aside at times when we've been in a jam. We currently don't have an "on-call" system besides that if you are interested in working extra, you can call the staffing and scheduling office and make yourself available, which is essentially putting yourself on call. They may confirm your request at the time of making yourself available if they really need you. Otherwise, the staffing office or the charge nurse do the call list. Fortunately for us, we have a lot of RN's that want and like to work overtime.

neonurse18 · May 4, 2006

Hello, I'm a NICU nurse and have been for roughly 6 years.

There definitely is a nursing shortage in the NICU where I currently work. We have mandatory on call, which usually means we have to work at least one extra shift per pay period. The nurses are really getting "burned out" & we are having some quit the profession, transfer to other hospitals, or transfer to other units. Our manager is trying to hire in, many of the new nurses are new grads and lack experience in the NICU.

I think especially on day shift it is more stressful not having enough staff because more of the tests and procedures are done on day shift. I frequently am the charge nurse in the NICU and am in ratio because of the shortage and many times have to be the admit nurse, relieve other nurses for breaks, attend deliveries, help with tests and procedures, take the transport nurses assignment when they leave for a transport, deal with all of the ancillary services and other problems in the unit, answer phone calls, and know that there will be frequent interruptions throughout the day! It is a stressful environment, but I truly love the NICU, but can see why other nurses feel they don't want to put up with all the chaos, that's why they leave.

Also our unit is so small, therefore there is equipment everywhere & we have a hard time getting things done without someone being in our way or having to go into another room for supplies.

A solution to our problem is to hire more experienced staff & get a new unit with more space!

neonurse18 · May 4, 2006

Also part of the solution is to keep the charge nurse out of ratio, so we can be there to assist other nurses and help out with admits, etc. There is no $ differential for taking the charge nurse role, that might be an added bonus, because of all the responsibility involved and the amount of work the charge nurses do!