how to prevent burnout...

[MassED]

So I've been doing this ER thing for some time. I would think that I can hang in there for much longer, as I'm only 41..... my issue lately has been the lack of quality nurses that are being hired. Many with no ER experience, or very little, or just floor experience. I was given a chance and was able to get into an ER, so I feel like it's possible to find a nurse that's a great ER fit. I try and try to find redeeming qualities, but when the majority of those around you make you fearful for those patients or having them help you, I wonder what to do.

There are many who feel this way. Management, of course, doesn't see what we see. I try to mind my own and just do my shift, but of course you care about those patients who have these unfortunate nurses. By unfortunate, I mean those that lack the ability to think ahead quickly, help your team mates, anticipate and find our residents for their needs, or to stop and disagree when there is a concern about a patient.

Examples of nursing mistakes/oversights are: Hanging Bicarb free flow, not on a pump, is one example. Another is a nurse asking how to hang blood (who also happens to work in critical care). Making a patient with 103 temp sit in our lobby, not masked (hello MERS!), not given Ibuprofen or Tylenol - which is part of our triage protocol. I could go on and on, but considering I'm starting the first of three shifts tonight, I better cool my jets. My usual M.O. is to avoid those that really frustrate me, but you have to be able to work together and lean on each other in the ER. I feel like it is one-sided, though, and I definitely do not want their "help" as their is a distrust in their skills. Of course not ALL of my coworkers fall into this category (it's a busy level 1), but it only takes a few rotten apples to ruin the lot.

I do realize my experience allows for me to anticipate certain things in the ER. I do not expect others with less experience to do this, but I expect nurses to be cautious, if not overly cautious, rather than disregard common sense. There's a culture I have noticed in the past 4 years of newer nurses (not necessarily younger, sometimes quite the contrary) not really caring about their coworkers, not helping with their call lights, or walking their patients - or even giving a med when you know your coworker has two septic patients.

I feel like courtesy is something that is ignored or certainly not considered an expectation in nursing school. Maybe this is something that is personally important to me. I'd like to think that people can change when you lead by example, but sadly this is to no avail. I see that many (from charge on down to techs) really don't feel pressure to get their work done, help others, and then sit down to chat. We all like to decompress with a good chat, but with anything, you have to have the right moment.

So, with vacation coming up I've made a vow to work on my perspective. Maybe it's me. Maybe I'm not giving these nurses an opportunity to learn, or see what they don't know. Any suggestions from nurses who have been around for a bit?

Thanks!

[MassED, BSN, RN]

Carmel, thanks for the post, will look at those books.

[SJGH1982]

Well, (with a deep breath), as a Canadian nurse with 32 yrs plus as a full time nurse -and the last 14 of it full time in the ER - I really feel for you 'young ones' - as I call all the new, young, fresh ER nurses. And - to be honest - a LOT of them do just fine. But - there are Bachelor of Nursing or Masters of Nursing Prepared new RN's, who just aren't prepared properly for the blood and gore, and poop and sputum and vomit among other things, that is the reality of ER nursing. Not their fault. But some move on - some choose to stay. Some that choose to stay do just fine - but I wonder - how can you do this for 30+ years? If you can - kudos to you. But it will get you in the end - either physically, mentally, via your home/family life ----it will. Sorry to be a "Debbie Downer" - but been there done that -and still doin' it and watching my young ones do it too. My only bright spot is that I can get out before too long. They can't. I worry for them, and for who will look after the patients when they can't do it anymore, and for the patients.

[MassED, BSN, RN]

Thanks, nippardjoe. I do agree that one cannot work at this pace forever in ones nursing career. It can be quite often running flat out sprints all night without nary a reprieve for peeing or eating. There are slower times when that's when you look around and say "well this is the payback we get for our horrid summer nights and tourism." I think it is less about the poop, blood, or gore, but more of a lack of respect by people in general. Visitors, coworkers, physicians, etc. In general, our society (I know you're Canadian, so correct me if it's very different there) is impatient, frustrated, quick-tempered, ill-mannered and sick. Not to mention we chart solely to defend our actions or nursing. We chart the foul-mouthed and our responses, knowing that if they complain, our charting will speak for itself. It's ridiculous that we have to be part lawyer when it comes to our job. We are doing the right thing, but knowing we can truly harm someone, or often times offend through our "we have to get this done right now and there is no time for padding things and fluffing and buffing." I can't tell you how often my tasks of meds, IV's, labs, etc are interrupted for "we need a pillow/blanket/socks NOW." Excuse me, but last I looked we really are trying to care for your medical needs, then we can get to the basic needs. There are many who will say "that's a part of our job," but Florence Nightingale days are over. We often do the work of 5 nurses, much to the detriment of our own health, yet are pulled down by staffing and budgetary concerns that could help us (volunteers to round for blankets, pillows, socks - even water if able).

Where I work we have quite a lot of mentally ill, which that alone can really eat at me. It is difficult to fight any battles when one is not equipped to cope or handle their own illness. The patients that I care for really are the only reasons I do this job. There's a few out there that really put things into perspective for me, as you never know when a moment will just sync and you know you're in the right place at the right time. I often say that a simple "thank you" or "please" erases all of the negatives prior to that, but it rarely happens. I do think that at some point, physically, one has to move on to a less trying job. I am told I smell like a sweaty kid that's been out on the playground after each night shift. Nice. At least I know I'm burning some calories, eh? (lol!)

[SJGH1982]

I TOTALLY agree with you about the lack of respect issue MassED. And the politics of the institution, toxic work environments, poor management - I could go on and on - they all interact together make the ER a place to work that we sometimes at work jokingly call "The Pit". Or worse. Anyhow - we "keep calm and carry on". Thats what we do!