Ready to leave bedside after only 1 year?

[Corpsman2OncRN, BSN, RN]

I'm an inpatient oncology RN working in NYC and just had my one-year anniversary in December (first nursing job).  I love oncology, I love my patients (well...most of the time, anyway :p), and I love almost all of the RN's and PCA's I work with.  However, over the past several weeks I have grown increasingly worn out and truly dread walking into work.  I have so much anxiety now about how short-staffed we will be (repeated staff "high-risk" exposures leading to two-week quarantines have left those of us picking up the slack exhausted and often having to work 24-hour shifts).

I'm an anxious person by nature, but it has been so much worse lately to the point where it's hard for me to even find the bright spots during a shift or for me to find that "why I'm doing this" feeling that can usually carry me through.

I feel that I still have so much to learn working bedside, but so many of my coworkers are leaving and it's making me feel like I want to do the same as things just seem to be getting worse and worse and more responsibilities dumped on us to the point that I feel like my license, and worse, my patients' safety, are all in jeopardy because of unsafe ratios and new policies like not allowing patients to be on a one-to-one unless they are suicidal (not that we often have one-to-ones, but delusional/non-redirectable patients can't be managed by a camera especially when half the time the camera operators don't even alert us when something is happening, and Q20min checks are just unrealistic for one person to keep up with all day while still trying to take care of the rest of their patients).

I feel like if I leave the bedside now, I won't ever come back, and so I am hesitant to do so and miss out on increasing my knowledge and skills when I'm a still relatively new nurse.  I also feel awful when I look at the nurses who have been working bedside for like 30 years and think to myself that I can't even make it to two years before needing a break.  But I can't even enjoy my free time anymore; I'm either exhausted from work and sleeping it off or spending the day dreading going back and seeing what kind of nightmare awaits me.

I am currently in counseling (not specifically because of this, just for general depression/anxiety), just as an FYI if anyone wanted to suggest that.

I don't even really know what I'm asking here but I guess I am wondering what people's thoughts are and whether it would be a mistake for me to leave the bedside now, so early in my career, just because I am feeling stressed?  Just to reiterate, I *do* enjoy being a bedside nurse, it's just that this whole year has been so hard with COVID and getting inappropriate-for-our-floor admissions and policy changes that throw more work on the nurses and staffing shortages etc. etc. etc... I know many of these problems are just the realities of working inpatient but I feel like I'm at my wits end here.

Any advice would be so appreciated!  Thanks for reading.

[martymoose, BSN, RN]

not sure I have any advise, but I sure do sympathize with you. You sound like you work where I work. ?

I am in your exact spot. And I think, yes , if one is prone to anxiety/depression, this makes it that much worse. I take some meds for that , yet they are doing nothing to help. I have found counselors don't help.

Especially since you actually care about giving proper care to you patients , and cant cause your hands are tied( and your mouth taped shut, so to say) That is what hurts the most. Many of my coworkers don't care the same way, or have a plan in place ( like going to NP school, and knowing they aren't going to be doing this forever)

All I can offer is a virtual hug; you are not alone.

[LibraNurse27, BSN, RN]

24 hour shifts?? As in you stay awake for 24 hours and are expected to function and take care of patients? That sounds insane and I didn't know it was legal. How much time off do you get after that? Doesn't sound safe for patients or for your personal mental and physical health. Sleep deprivation is dangerous, and the risk of making an error goes up by a lot. 

If you enjoy bedside, try to look for somewhere with better staffing and no mandatory overtime. Many hospitals have these problems, though, so it may take time. If you don't enjoy bedside and don't think you'd want to go back, by doing Oncology you can probably get into an Oncology clinic or Infusion clinic since you can give Chemo. What are you interested in doing next? = )

[TheMoonisMyLantern, ADN, LPN, RN]

I know things probably seem pretty bleak where you're at. Honestly, though, many facilities have kind of an ebb and flow when it comes to staffing. It'll get better for a while where you have just enough to handle things and then something will happen that sets people off and they start leaving. It can be tempting to join in when it seems like all your peers are jumping ship, however I've learned that jumping ship isn't always the answer. Have you taken any time off? If you haven't and you have PTO, I'd really advise trying to take a little time to relax and get away. Is it possible to transfer to another unit? Have you gotten certified in chemo? If you have then outpatient oncology would be a strong option, if you don't have it I would advise you to obtain it before you jump ship.

I'm not sure how frequently you see your therapist, but increasing the frequency during this time of high stress can be helpful. 

[Corpsman2OncRN, BSN, RN]

3 hours ago, LibraNurse27 said:

24 hour shifts?? As in you stay awake for 24 hours and are expected to function and take care of patients? That sounds insane and I didn't know it was legal. How much time off do you get after that? Doesn't sound safe for patients or for your personal mental and physical health. Sleep deprivation is dangerous, and the risk of making an error goes up by a lot. 

If you enjoy bedside, try to look for somewhere with better staffing and no mandatory overtime. Many hospitals have these problems, though, so it may take time. If you don't enjoy bedside and don't think you'd want to go back, by doing Oncology you can probably get into an Oncology clinic or Infusion clinic since you can give Chemo. What are you interested in doing next? = )

If you work 24 hours you are entitled to a four hour break so we usually will go to sleep for those four hours which is a help.  But I agree that it is dangerous and myself have only done it twice when the night shift staffing was so abysmal that I could not in good conscience leave.  For time off, if you were supposed to work the next day you would get the day off but this cycle of RN's doing 24's has then left the day shift short because the night shift was short so it's like no matter what we're all screwed.  SO frustrating!

I do enjoy bedside but I just feel like maybe I need a break right now.  I've thought about outpatient chemo since I do like oncology...that might be something for me to look into.  Thank you!

[Nunya, BSN]

Please notify your BON and JC about those 24 hour shifts, I'm pretty sure they'll have a few things to tell your hospital about them. 

[Jedrnurse, BSN, RN]

7 hours ago, TheMoonisMyLantern said:

 Have you taken any time off? If you haven't and you have PTO, I'd really advise trying to take a little time to relax and get away.

If staffing is such that they're pulling 24 hour shifts, I doubt that much PTO is  being granted...

[EDNURSE20, BSN]

Honestly I don’t think it matters where you work right now, most nurses are worn out. And a new job probably won’t change things that much. if you enjoy oncology, and the staff there, then you probably better off staying.

take a break, which I know is hard. but even if you can get leave approved for a few month away, at least you have something to focus on and look forward too. See how you feel after a break, with a clear head you will make better decisions. 

also ignore your phone on days off, don’t let them talk you into working more hours! I know as a newer nurse it can be tough to say no, or ignore calls. But it’s an important lesson to learn, and will still need post pandemic. 

[TheMoonisMyLantern, ADN, LPN, RN]

2 hours ago, Jedrnurse said:

If staffing is such that they're pulling 24 hour shifts, I doubt that much PTO is  being granted...

Hey now it had to be suggested. Every burn out thread requires us suggesting the poster should either take a vacation or quit their jobs. Just doing my due diligence ?

[Nunya, BSN]

Have you thought about another area of nursing? I actually thought about doing oncology my first job as there was a very prestigious oncology hospital in the city I was in, but I decided I really wasn't emotionally ready for that as my first job.  Every job will have bad things happening, and then there's Covid but some jobs have less bad things than others.  Maybe you can transfer within your hospital, or one of the other dozens (? hundreds?) of hospitals in NYC? 

[Hannahbanana, BSN, MSN]

Historically this topic gets around to “I couldn’t refuse, they said they’d report me to the board for abandonment.” As a brief refresher:

A facility can mandate overtime for an emergency. However, multiple court decisions have established that a long-standing  pattern of mandated overtime due to short staffing is no longer an emergency, but a management failure. 
None of us went into nursing to give substandard care or ruin our own health. The only way to force adequate staffing is to refuse to play that game. Refuse to allow the staffing office to bully you or guilt you into it “for the patients” or “to support your friends.” Amazingly, if nurses do that, hospitals start getting pressure from patients and physicians, and amazingly, they start hiring. 
In a true long-standing shortage, they’ll hire travelers at tons-o’-bucks per shift. They do budget for that, count on it. It’s not a sustainable model, and they know that too. They threaten unit closures, especially scary for new nurses who had a hard time getting this job and feel that if they don’t show loyalty here they’ll never get another one.
This tactic was especially useful for the hospital industry when mandatory staffing legislation was up for consideration. They may close units briefly but not long, because bodies in the beds = income. Meanwhile, extra layers of management and consultants mean money not being spent on bedside care.

The historically effective way to counteract this divide-and-conquer strategy is to be indivisible. If your state nurses association isn’t strong enough, form your own union. Yes, you can. Been there, done that, and won.

Or you can keep working for a coercive structure that burns out nurses left and right, and produces posts like these. Your choice. 

[TheMoonisMyLantern, ADN, LPN, RN]

14 minutes ago, Hannahbanana said:

Historically this topic gets around to “I couldn’t refuse, they said they’d report me to the board for abandonment.” As a brief refresher:

A facility can mandate overtime for an emergency. However, multiple court decisions have established that a long-standing  pattern of mandated overtime due to short staffing is no longer an emergency, but a management failure. 
None of us went into nursing to give substandard care or ruin our own health. The only way to force adequate staffing is to refuse to play that game. Refuse to allow the staffing office to bully you or guilt you into it “for the patients” or “to support your friends.” Amazingly, if nurses do that, hospitals start getting pressure from patients and physicians, and amazingly, they start hiring. 
In a true long-standing shortage, they’ll hire travelers at tons-o’-bucks per shift. They do budget for that, count on it. It’s not a sustainable model, and they know that too. They threaten unit closures, especially scary for new nurses who had a hard time getting this job and feel that if they don’t show loyalty here they’ll never get another one.
This tactic was especially useful for the hospital industry when mandatory staffing legislation was up for consideration. They may close units briefly but not long, because bodies in the beds = income. Meanwhile, extra layers of management and consultants mean money not being spent on bedside care.

The historically effective way to counteract this divide-and-conquer strategy is to be indivisible. If your state nurses association isn’t strong enough, form your own union. Yes, you can. Been there, done that, and won.

Or you can keep working for a coercive structure that burns out nurses left and right, and produces posts like these. Your choice. 

Have these court cases been federal or state based? Where I live antiunion propaganda videos are shown during system orientation and company statements posted in breakrooms that under no uncertain terms threatens separation of employment if unionization attempts are made. There are no nursing unions statewide where I live, and what little union presence there is in other occupations boast an anemic influence at best. I say all this just because I just don't have confidence that us peons can make meaningful change without jeopardizing employment.