Seeking advice for possible position change

[TokenMurse]

I feel like I have no one I can talk to about this who understands, so I'm hoping to get some advice from fellow nurses. Warning! This is a long rant.

I have been an RN for 13 years, and I worked as a CNA for 5 years before attaining my RN. As an RN I have always worked at the same hospital, on the same med-surg unit. I have been a charge RN for the past 7 years and, to my delight, for the past 4 years I have worked as a weekend option charge so my wife can stay home like she's always wanted.

Here's my dilemma: it's terrible. We are always so short staffed that I can't remember the last time I charged with less than 6 patients (had as much as 10). The overall experience level on the floor is dismal, with the average nurse on the unit having less than 2 years experience and the turnover is constant. I am incessantly training in new grads whom I feel like I am doing a disservice because I can't take the time to dig in with them like a preceptor should. All we have time for is to run from task to task with no intervals to look deeply into our patients. And speaking of breaks, I haven't taken a lunch in literally years--and I'm not alone in this regard. The "staffing crisis" has been going on for years and I have tried to stick it out for multiple reasons, but I feel like our leadership is not only NOT helping, but at times it's like they are working against us. For instance, they took away our phlebotomy team and didn't even train the nursing staff on phlebotomy. This isn't to say I didn't know how, but I routinely have a unit full of new nurses who miss way more sticks than they hit and need me to draw blood and place IVs for them--and I already have, as a charge, more patients than our staff nurses are supposed to have in addition to my extra responsibilities! Here we are telling our leadership, "we're drowning'" while they smile and nod their heads, then they actually pull resources away and pile onto our responsibilities! Now they want to integrate PCU level patients into our unit (by acuity score over 30% of our current "med-surg" patients are already PCU level--it's a busy unit), so they want to install monitors and train us on different drips. They plan on going live with this in October. I told them I don't read strips, have never worked with these drips, or fresh trachs, and that I didn't feel comfortable charging the unit unless I could work PCU for a couple years under some competent charge nurses; until then I couldn't be a resource to our staff. They basically said we're all gonna learn as we go and iron out the kinks. Oh, and by the way, we have no more staff! They just want to add to the acuity of the patients we care for with up to 6 official PCU level patients. I already worry about who might die under my care! I worry what my new nurses might be missing when I don't have time to review orders on all patients. I worry about labs that are delayed for hours because we have no phlebotomy, and we are staffed to the point patients are waiting a half an hour just to have their call light answered to recieve the most basic care. Now they want to do this?

I am breaking. I am burned out. I leave work everyday (for years now) feeling like I am being forced to give substandard care, and generally feeling like crap about myself. For the past year I have been getting sick (vomiting) before work and getting terrible headaches. Sometimes I cry uncontrollably because I am so anxious about what situation I am going to be put in at work. I was never this way before. I went years without missing a shift and now I call off because I'm so anxious I can't stop vomiting. To be clear, no one at work knows this. Everyone thinks I'm the cool, calm, and collected charge nurse--because I always have been and I can project that still for the sake of my co-workers--but inside I am reeling.

Here's my dilemma: I want to leave my unit, but leaving means no weekend option (a likely 30% pay cut) and I don't want my wife to have to go back to work, so I feel trapped (She thinks we could tighten our belts and get by). I could leave for a different hospital but I love where we live and don't want to move so I'd be driving an hour each way. Also, I have all this med-surg experience but I am afraid it's going to be the same no matter where I go; I am considering going to the psych unit in my hospital, but I'm nervous because it would be like starting over since I have very little psych experience.

I guess my questions are these:

1. Am I being crazy--are these normal working conditions and I'm just too burned out to cope?

2. Should I take a pay cut and leave for a new hospital (1 hour drive one way) or look for weekend option in med surg somewhere else because it is NOT this bad elsewhere?

3. Should I abandon my experience and try psych (and take a pay cut)?

4. Any options I'm not thinking about?

Any and all advice is appreciated.

[jobellestarr]

Wow. Your job sounds completely awful. Have you thought of transferring to something where the patient population is a little more controlled like outpatient surgery, inpatient dialysis, etc? Something where you could use your wonderful m/s skills? Do you like psych? Or are you looking to escape acute care? If it’s something that you have an interest in, go for it. I think the takeaway is you have to take care of yourself first. And your current job is affecting your health. Good luck to you ❤️

[NightNerd, MSN, RN]

Holy smokes! I'm sorry this has been your experience for so long. It sounds like you are a great asset to your unit and want to do the right thing; it's a shame management will not step up to the plate with you.

It's not normal that it's like this, but I too would be wary of moving to another hospital, lest you find out it's just as bad. That said, every place has its issues, so you have to find the one that lets you have the rest of your life back. If you are experiencing physical symptoms and mental and emotional strain as you describe, something needs to change. Your unit appears disinterested in that, so unfortunately that leaves it up to you.

I know you said you don't want to take a pay cut because it would mean your wife possibly needing to go back to work. How does she feel about that? Is it an option, even part-time or temporarily? What you're doing now for her is really great, but I'm sure she doesn't want you stuck in a job that makes you miserable. As you mentioned, maybe cutting back on some spending could also make it more feasible to change jobs, although I know it's hard to do that.

It sounds like you have a solid med-surg background behind you, which is great; that can take you a lot of places. If you investigate psych and decide it's genuinely of interest, go for it, but I wouldn't do it just to get out of your current situation. What are the other medical units of your hospital like? Would it be an option to try a different area where you will be the newbie for a little while? Or is the poor management pretty much across the board?

[Corey Narry, MSN, RN, NP]

1. I experienced the kind of unit you have when I was a new nurse and yes, it was a revolving door for new RN's and I can't recall anyone who was there for 13 years. It was "normal" working conditions for poorly managed units and that was the conclusion I came up with as soon as I left and found better. However, I switched out of Med-Surg to ER. The other Med-Surg units are similar from what I recall.

2. I would research that other hospital before transferring. They may be no better as you suspected.

3. If you like Psych, sure. That's a whole new world and while it's not my interest it's a good stepping stone for Psych NP...which has good employment options.

Sorry, you're having a rough time, good luck whatever you do.

[JKL33]

Get.Out. Do not spend time in this insufferable situation because of various apparent dilemmas. You are on the precipice of knowing I'm right about this. Admit that life can work out some other way and things will be okay (likely way more than okay).

If you think you feel bad now, wait until they convince you that your concerns about "learning as [you] go and working out the kinks" is because there is something wrong with you and your lack of "resilience."

Just don't go there. Stop feeling bad for not enjoying abuse.

Decide that you are not staying here. Once you do that you will be better able to recognize other possibilities. Work through the other possibilities with your wife making sure she first understands that staying is not an option and that when the work involves patients' well-being, there is more at stake than at some other crappy workplaces. Make your plan and get out.

You will feel better the instant you stop blaming yourself and make an empowered decision.

Best of luck.

[Nurse Beth, MSN]

What JKL33 said.

Leave. Whatever choice you make will be a life improvement.

You are a little paralyzed by fear and seeking confirmation of how bad it is (YES IT'S UNTENABLE) and permission to flee (GO).

Whoever gets you will be lucky and I am honestly feeling angry at how you have been treated, not to mention that they are unethical and unconcerned with patient safety.

[Lunah, MSN, RN]

The more you give, the more they will take. It is so hard to shake the helper mentality, but you are spread beyond thin to the point of holes starting to appear. Change jobs and change your life. Your health is not worth all that! You will be a huge asset wherever you land. Believe it. Best wishes.

[L-ICURN, BSN, RN]

Look at your household budget, do some cutting somewhere, and change jobs.

[TokenMurse]

I want to thank you guys for the responses. Your words were just the push I needed to make up my mind to pursue a positive change. I am not going to our psych unit, rather I have decided to drive to the other hospital. I actually know several nurses who left to work there and I had an opportunity to reach out to them over the weekend; what they told me is really encouraging. Staffing is world's better, they feel supported by their leadership, their base pay is actually much higher than my current facility, the night shift differential is over 4x my current diff, AND they have weekend option positions currently available! Also, I won't have to charge which is such a relief; it'll be nice to not have to worry about all the little extras and just focus on good patient care. So far it sounds like a better working environment and better pay to boot; I'm actually kind if excited(the first time in a LONG time)!

However, just knowing that I will be leaving has already lifted such a burden from my chest. Even before I found out I likely would not have a pay cut I felt so much better.

Again, thanks for the advice, and the push.

[JKL33]

@TokenMurse Good for you.

After you secure another position, leave this one on the best possible terms; give a proper professional notice and a decent resignation in which you say whatever thanks/nice things you can say genuinely. Don't let your years of service/loyalty tempt you to share how you wish things were or why you are leaving; they should know (well, they do know) everything they need to know already about their turnover, and the people who need to care don't. So keep your plans and especially your reasons on the DL and in general just don't talk too much. No need to invite resentment.

Things are looking up!

Much luck! ?

[bugya90, ASN, BSN, LVN, RN]

RUN! I worked on a M/S Renal and Cardiac overflow unit for a while. We maxed out at 6 and our Charge usually did not take patients but on the rare occasion she did she was maxed at 2. It was tough but manageable most days. Our unit management would come help out during the day shift when needed (especially at med pass times) and at night the hospital supervisors made rounds on all the units to help as needed.

I promise not all M/S units are bad. If you truly love being a M/S nurse there are plenty of hospitals that would love to have an experienced nurse like you. However if you are tired of M/S and the high volumes/acuity there are tons of other specialties out there. You could also look at the outpatient world too. I am now in ambulatory care and loving it. The hourly base pay is more for my ambulatory job than it was hospital but I don't get any shift differentials and rarely have OT so I don't bring home as much most weeks.

Have a long discussing with your wife, look at your budget, polish up the resume and take the leap of faith. With your experience, I don't think you will have a problem landing a new job. Research the places you are applying to and ask around about their reputations. Nursing is a small world and you most likely know someone who used to work there ?

Good luck!

[mimibrown, ADN, BSN]

I've done tele/medsurg "flexing" up to six patients. It is hard but doable. Drips, PCU level patients, running charge, no breaks, drawing your blood and everyone else's with a full assignment, sounds like an absolute disaster. This is completely unsafe. I would be updating my resume yesterday. I agree you need to run. I do think you sound like a great nurse who should have no problem finding a better job. Good luck!