Ativan

Curious1alwys- I constantly fantasize about going back to waitressing/bartending, being a dog-walker, ANYTHING but what I'm doing now sounds like a relief from the stress for a while. And you're not a wuss (although sometimes I feel that way when I see other nurses who don't seem to struggle like I do). It's not normal or healthy to be beaten into the ground without a break for 12+ hours and not get burnt out. But, even though I know this is the last thing anyone in our situation wants to hear, give it time before you quit. Try a different floor, a different shift, a different type of nursing, a different hospital. I've had jobs that are better or worse about lunch breaks, pace, getting everything done, etc. I float to every unit in my current hospital and I see wide variation in this, and, at least in my state with ratios, night shift is a much better pace and they get hour-long breaks. If/when you start feeling burnt out on just dealing with patients, it's harder to just switch units and get away from that. But the world is not kind to newer nurses looking to get out; almost every job posting I see requires at least 3 years, if not 5 or more. So, my advice is, try to find another job, but don't leave until you have something else locked up. Oh, and as far as leaving for minimum wage, I'm all for doing something you love and downsizing your lifestyle so you can afford it! Just remember, though, that your employer is not only paying your salary, but a huge amount for your health insurance, retirement benefits, and PTO. So you will have to make MUCH more than minimum wage to make sure you can have health insurance and take a day off once in a while. Also, while the job might be fine for a while, there is not much of a career path in waitressing or retail, and you're going to want to get off your feet and retire at some point. Say what you will about the stress of nursing, there are a lot of opportunities and paths to take. So, speaking to myself as much as anyone else contemplating a change- do it! But do it intelligently, have a plan.

Wow, thanks everyone for your support and encouragement! While it's good to know I'm not alone, I'm sad that this is what nursing can do to so many people like me and many others here who are clinically strong, have a desire to help people, but get burnt out by the system and many of our challenging patients/families/managers. Just for the record, I am seeing a mental health professional, and I have had the Xanax prescription for many years (before nursing school) and rarely used it until now. Also, I have been networking and building my resume for about 8 months now and I've been applying for jobs away from patient care. No luck so far, which is discouraging, but I'll keep at it, I know it's not impossible. I just have to find a way to deal with the anxiety and bad attitude while I'm looking. But honestly, I've only been halfway committed to getting out because... I'm afraid to leave the bedside. I'm afraid it will "ruin" my career and I'll get stuck in a dead-end job with no career path. I'm afraid I will lose all my skills and it will be impossible to go back to bedside if I ever want to. I'm afraid of admitting to people who supported me through years of nursing school that I don't like nursing. I'm afraid of leaving my current situation (where I have a flexible schedule, a pretty senior position, and a rare great boss) for an unknown. At least as new RNs, we sometimes get brainwashed into thinking that inpatient, critical care nursing is pinnacle of nursing and those who do it are bad-asses while working in a clinic or an office is demeaned as "where nurses go to die." I feel ashamed to "give up" at a relatively young age. These aren't excuses, I'm just saying this because I know there are people out there who feel or have felt like me, and some who have gotten through it to the other side and are glad they made the leap. So those of you who have felt like me and got out- where did you go? What do you recommend? Clinic? Insurance? Public health?

I've been a nurse for about 4.5 years. During the past year or so, I've started to dread waking up in the morning and going to work, so much so that I can barely sleep the night before without taking Xanax. The anxiety even creeps into my days off, as I subconsciously count down the hours until I have to go back and start to get depressed about it. During stretches of a couple days off, I'm generally pretty productive and happy. I've seen a lot of people post about dreading going to work when they are new nurses and overwhelmed with the learning curve. I did not have that as a new nurse. Even when I felt overwhelmed, I felt OK about going to work, even excited. Now, even though I'm more experienced, I have developed anxiety about what types of patients and families I will have to deal with, whether I'll be humiliated by any doctors that day, whether I'm going to be able to get everything done, whether I can physically and mentally make it 12 hours, and whether I'll be able to remember to document everything, etc. All the stresses of the job, I pre-worry and obsess over. When I'm at work, my anxiety isn't even that bad. Has this happened to anyone else? I suspect it's burnout. Has anyone been able to get through this? I take vacations and plenty of days off, I only work 3 shifts a week, never overtime, we have a great staffing ratio and pretty consistent breaks at my hospital. I'm feeling like my only option, for my sanity, is to get off the floor. I could try another hospital, another unit, another type of nursing, but honestly, I've worked in 3 different hospitals and multiple different units, and I find it to be all about the same.

Thanks everyone for your feedback! Integrated into the regular documentation and automatically generated care plans seem like the way to go! Our system (Epic) requires the RN to remember to go to a completely separate module to document care plans and another one for patient education, and it often doesn't get done. It also requires a lot of extra documentation for the RN that could just be done in the flowsheets.

We need to streamline and improve compliance with documentation on care plans & patient education at my hospital. Does anyone working inpatient think their system of documenting on Care Plans & Patient Education is working well? As in: nurses don't absolutely HATE it, it's not too confusing or overly-complicated, the compliance rate of nurses documenting is pretty high? What system do you use? Anyone have examples of interventions that were used in their hospital to streamline or improve the process?

Basically, you need to learn to edit and cut stuff out to get to just what's important. Then when you're caught up after lunch (theoretically), you can dig deeper into the notes, chart your care plans, spend more time chatting with the patient, etc. I don't use brain sheets, because I find it takes a ton of time to fill them out, and you can often look things up later if you need them. If you use computer charting, see if there is a way you can print out a condensed report (like whatever the residents use to keep track of all their patients). I know there is one in Epic called a patient rounding report. Then just write down or circle/highlight things that are especially important to find quickly (like code status for me). Use the computer as your brain- don't write down every single med you need to give at what time, just check the computer occasionally. You don't need to have every piece of information (last BM, last night's blood sugars) at your fingertips, you can tell the MD or patient that you don't know off the top of your head, but you'll look it up. Learn how to do focused assessments. Maybe this is controversial, but if the patient is in for cellulitis on the leg and eating and pooping normally, I don't spend time listening to bowel sounds, I just eyeball and gently feel their belly as I scan them head-to-toe. Also, if your hospital uses charting by exception, don't over chart! A lot of nurses chart WNL and then chart all the normals under it. It's a hard habit to break once you get into a routine. Communicate with your patients about your timeline and schedule. Say, "I'm going to do your vitals quickly right now and then I'll be back after your breakfast to give meds." That way they don't call you to ask for their meds, etc. Learn to make an exit gracefully: "I'm just making rounds to check in with all my patients and I'll be back in a bit to talk to you more." Ask and watch other nurses to see what kinds of nursing judgments are acceptable. In some hospitals, they are very strict about the timeline to give meds, in others (like mine), nurses routinely reschedule some meds and things like dressing changes to work better for their schedule, and no one cares (be careful which meds and dressing changes you do this with, though, this takes time to learn. IV antibiotics should generally be given on time). Along the same lines, if I have meds due at 1300, 1400, and 1500, I will give all of them at 1400 together (unless there is a specific reason why they need to be at certain times. I will often run that by the patient verbally to make sure that's OK with them: "I'll be back around 2 p.m. to give you these meds, does that sound OK?" Better to find out then instead of after the patient feels like you gave them their medication late). And of course, learn to delegate tasks to your CNA or ask for help from your charge nurse, other co-workers, or float/lunch relief nurse if you have one.

Good distinction, I guess that's probably true. If only there were a way to have it all!

Thanks ArmyRN789. What is a Nurse Methods Analyst and how is it different from an informatics nurse?

I actually have the opposite question, and I don't want it to seem judgmental, I'm genuinely curious. Why would someone with an IT or computer science background go to nursing school to become an RN, then work in an informatics role? It seems to me like someone with an IT background could do most healthcare IT jobs without being an RN, so why give up the money and time if you don't want to work as a nurse in the traditional sense? Are there more/better job opportunities? Do you get paid more for the same work if you are an RN? Do you go into it thinking you might like being a floor nurse, then change your mind? To answer the original poster's question, why become an RN only to work in computers- sometimes people change their mind. I have personally become burnt out from floor nursing and, as I see systemic problems that I feel helpless to fix as a floor nurse, I have increasingly taken an interest in using technology to improve patient care and the healthcare system in general. So, while I went to and came out of nursing school wanting to be a nurse working with patients, once I worked as a nurse for a while, things changed. And I completely agree with CraigB-RN, the ability to do tons of different things WITH your RN license/background (even working "with computers," many of the jobs require the RN background), including research, management, education, quality improvement, healthcare policy, case management, advanced practice, and informatics is a selling point of the nursing profession. I suspected that I would probably eventually get bored, so I went into nursing knowing I could do many things with it.

I know there must be sub-specialties in nursing/healthcare informatics, but I can't find much information about it. The main specialty I've encountered is the type of nurse that focuses on training and education of end users as opposed to the nurses working in software development and systems analysis. Those seem like very different career paths and necessary skill sets, so it's surprising to me that they are lumped together under nursing informatics, but maybe that's because the field is still relatively new. Are there other specialties in nursing informatics, and are there different career paths or skills to develop to go into them? I've seen references to nurses serving as software testers, systems analysts, project managers, marketing/product management, and performing research (I'm assuming this means studying the effect of software or other technology on patient care, either for product marketing or publishing in academic journals). Are there different paths to follow to go into any of these "specialties" or is the field too new? Are there informaticists that focus more on user interface and software design and others that focus more on data analysis or business intelligence? I have an interest in data analysis and also in user experience/interface and how that affects user satisfaction, quality of documentation and patient care. Wondering if I should take specific courses in data analysis or UX/UI and try to develop expertise in a specific area, or do a more general informatics program or take any informatics job and specialize later, if at all. Thanks in advance for answering!

\gypsyd8, don't give up! That's one person's opinion, and if he really said that your MSN is "useless," he sounds pretty untactful and overly confident. He might know what is valued by him in that organization, but not in all organizations for all time. Basically, the message I have gotten from lots of reading and posting and discussions with people in nursing informatics is that just a degree (ex: MSN in Informatics) doesn't matter much. The most important factors for getting your foot in the door with nursing informatics seem to be hands-on experience and networking. And it sounds like you are in a great position through this internship/clinical opportunity to get involved with a project and do some networking! It's all about how you position things in your resume, cover letter, and interview. I have an MSN with a specialty in a field of nursing I don't actively use, but in my experience, employers just look at the MSN in general as a check box, no one has ever asked me about my "specialty." I then tailor my resume to the job I'm applying for (focusing on work experience, projects, certifications that are relevant). So put the MSN under education, then really play up your informatics and computer experience elsewhere on the resume. And if there are any courses in your MSN that you think would bring you valuable skills to the job you are applying for, list those under education too (ex: coursework in program evaluation, quality improvement, change management, project management, negotiations, research methods, biostatistics, etc.). Most of those "soft skills" are also valued in nursing informatics jobs, like any job. And when you're doing that clinical experience, don't let that one guy get you down. Act like he could be gone at any moment (he could), and network with/impress everyone else there by showing up and being amazing and hard-working. If that particular job at that particular facility doesn't work out for you because they really want the MSN in Informatics, just keep looking! I have done tons of job research, and I know that particular degree is not the determining factor everywhere. Good luck! Consider yourself lucky that you have this clinical opportunity and make the most of it!

Lots of great responses, thanks everyone! It's interesting that there is a big split between nurses who think charting at the bedside is the fastest and those that are against it (either because it's distressing to the patient or takes too much time). I also notice that nurses who are best at charting in "real time" seem to be those that view it as a high priority up there near patient care. I admit, this attitude doesn't come naturally to me, but might be an important mental shift. I've done ED nursing and floor nursing, and the thing I miss about ED is that things get done in the order of what's most important and urgent, not arbitrary deadlines like "9:00 meds." So (unless there is a really serious situation) you can do, chart, do, chart, and not worry about late meds or getting your Braden score documented by a certain time of day or whatever.

Thanks for your response! It sounds like 100% of the informatics nurses I've asked about this are considering a return to the floor. But then again, 100% of the floor nurses I talk to are trying to get off the floor, so maybe it's a "grass is greener" phenomenon! Therefore, it seems like no matter how much thought I put into it, I might never be truly "ready" to give up patient care forever. I like your comparison of the satisfaction of completing a project with the satisfaction (and adrenaline rush!) of helping a patient. It's good to know there are similar experiences. Thanks!

Thanks everyone for all the great responses so far! I have two additional, but related questions (and updates): 1) I did make some progress towards becoming a Super User! However, I'm struggling to find resources to learn more about advanced features of our EHR (Epic). I got one class when I got hired, I've forgotten most of the stuff I don't use every day (like smart phrases), and I can't find ANY additional resources on our intranet or through our continuing education department. Are there any resources out there for learning how to do things in Epic? I know it's different in every hospital that uses it, but I'm wondering if they have videos or courses or forums or any resources I can use? 2) Networking with people in the IT department is a common theme, and I couldn't agree more. Do you think that night shift workers have an equal or at least adequate opportunity to network with the IT department or work on IT-related projects, or should I really be focusing on getting a day shift position? I have worked both, and I find that I'm more stressed and less able to chat with my co-workers and play around with the computer on days, but maybe the networking opportunities outweigh the extra stress and busy-ness of days? Thanks!

Are you good at charting/documenting in "real time," that is getting your assessments and vitals charted close to the time you actually do them instead of catching up with charting hours later at the nursing station? Any tips for how to do this successfully without delaying the rest of your care? Are you faster at documenting than all your co-workers, and if so, any tips? Our hospital is pushing nurses to start documenting closer to real-time because the charting will be linked to patient acuity. I'm curious to see if this is actually humanely possible; looking for examples of nurses who successfully do this. Thanks for any advice/opinions you might have!

Mydesigyn, Thanks again for the detailed information! From your description, I can see the difference between the two paths and I think the role of systems analyst is what I'm looking for. Most of the jobs I've looked at specifically request a BS or MS in computer science or a related field AND clinical experience, which seems like it must be pretty rare, but maybe not? I have a Master's in Nursing, which I'm still paying off, so I'm a little reluctant to jump back into the huge time and money investment that may not actually raise my earning potential much. Do you think something like a post-baccalaureate or post-grad certificate or some extra classes taken at a community college will make me more marketable in the IT department, or will I need that formal degree? I have done case management before, so I might look into that as a bridge, and research also intrigues me. Do you mean research as in being a research nurse for clinical trials at an academic institution? Enrolling patients, etc?

Mydesgyn- Thanks so much for your thoughts on this! I had never thought to get a more general degree in information systems that might be useful for transitioning into other fields as well. Can you think of any examples of other fields or positions a nurse with an IS degree could transition into? Do you think nursing informaticists generally develop the technical skills to transition to other IT jobs, or are they mostly valuable in a healthcare setting because of their clinical experience? gollybabbler- Thanks! I will definitely take a project management course or two. Just out of curiosity, why did you leave IS nursing and what are you doing now? Thanks so much for the responses, they are very helpful!

Thanks everyone for your responses! I think the message I'm getting is that I just need to learn to hand over responsibility sometimes and not try to do it all myself (sounds obvious, but sometimes hard to do in practice). I should have handed over more tasks to the critical care float nurse without feeling guilty, and I should have asked the charge nurse more directly to help with specific tasks rather than expecting her to be aware that I needed help and offering it. Some are better than others! I think the hardest thing for me in nursing is asking people to do things without feeling bad. Sometimes you can't get EVERYTHING done by yourself and wrap up each patient in a nice little bow right at 7:00. But I hate feeling like I'm getting an eye roll or a dirty look when I pass something on or ask for help, so I guess I'll just have to get over it.

Ok, so there are a million posts out there on how to get into nursing informatics, and most of them suggest trying to take on some informatics-related projects at your organization, like being a Super User. What if, hypothetically, your boss and/or organization was not being super supportive of you trying to get more involved and you had to go outside the hospital to get more experience and education? Things I'm looking into: 1. Volunteering in the community in computer-related volunteer roles (to demonstrate basic computer experience/skills) 2. Learning about computer programming, databases, and general informatics concepts with online CEU courses or MOOCs (through Lynda, Coursera, etc.)- can I put this on a resume?!! Is education in programs like Excel and Access worthwhile, or do employers mostly want to see experience with the big EHRs? 3. Joining HIMSS or ANIA-CARING and going to events and/or conferences (expensive, is it worth it if you're new to the field?) 4. Doing a formal education program like a master's (expensive, and seems that this isn't that useful unless you have experience). Anything I'm missing? Any thoughts on what types of courses or skills would be most transferrable to NI (Excel, SQL, programming)? Thanks!

I'm interested in transitioning into NI, so I've interviewed a few nurses working in similar roles, and they often express disappointment that they don't get the satisfaction of working directly with patients. I'm feeling a bit burned out on patient care right now, so I guess I didn't give much thought to missing it, but it seems to be a common theme, so I want to investigate it further. If you're a nurse working in an informatics role, do you miss working directly with patients? Do you think you could go back to patient care if you wanted to? Do you get enough satisfaction from your job that you are helping care providers provide better care to patients, or do you miss having that hands-on impact on patients? Thanks!

How do you handle the rest of your assignment when you have one patient in a critical situation, like a code or rapid response? I've had this happen a few times where one patient is unstable, I'm basically 1-1 with that patient giving meds and monitoring them, and I'm waiting for a bed on a higher level of care, but the unit secretary and other staff are paging me about my other 2-4 patients needing pain medicine, blood sugar checks, etc. Plus I have their routine meds to give, so during the (way too long) time it takes to get a bed on a tele or ICU floor, I am neglecting and getting way behind on my other patients. There is usually a critical care float nurse who stays with the patient, but I feel bad completely ditching her with my patient and asking her to give all the meds. This happened to me the other day on med-surg, it took 1.5 hours to get a tele bed for a rapid response patient, and during that time, I was busy trying to put a Foley in him (unable, that was part of the problem), give meds, communicate with the doctors and the family, and monitor his pressures and rhythm from the crash cart (HR was in the 150s). The charge nurse (who doesn't have an assignment) was irritated at me for asking her for help with my other patients and said I should just leave him with the critical care float (who was busy filling out her paperwork on the code and monitoring the patient, not watching for orders and carrying them out, so I would have had to explain to the nurse I transferred him to why none of his orders were carried out). Another nurse took pity on me and offered her help. I'm a float nurse, so I don't really know many people on any given unit, so it's tough to get support. My question is, how could I handle this situation better? Is it OK to leave my patient with the critical care float and ask her to basically take over the care? Is it normal and acceptable to ask the charge nurse to either help out herself or request other nurses help me with my assignment? Should I directly ask other nurses to do things for me, like pass routine meds? Or should I stay late catching up on my other patients?

When I recently renewed ACLS, as I was running through my mega code scenario and I got pulseless Vtach, I said to shock the patient, and the entire class, including the instructor, all said, "no it's PEA because there's no pulse." Never mind how I explained it and showed them the algorithm card, I kept getting push back. I thought I had gone crazy and lost the ability to read until the instructor later came back to me and admitted he was wrong. So maybe the concept of PEA is sticking a little too well!

A dialysis nurse rang the patient call light to let me know that the patient had "suddenly become unresponsive and had no blood pressure." I was the only nurse on the floor and was doing a dressing change in another room, but heard the call light going off for several minutes before I got in there. The patient was grey and obviously dead. The nurse was still fiddling with the dialysis machine. BTW, can any nurses out there tell me what could cause a patient to suddenly die right after being hooked up to a dialysis machine? I'm thinking clot? Is it nurse error or just bad luck? Thanks.