Stress related near breakdown

[inthesouthrn]

I've been and RN for 16 years. After graduation, I worked on a med/surg floor for 1 year then went into home health. That is where I stayed until 3 years ago when I went back into hospital nursing, med/surg. I did pretty well getting back into the swing of hospital nursing, however, I do find it very stressful and physically as well as mentally challenging. I have been handling it well for the most part however. I am in my late 40s.

However, the last several months, on those very stressful days, (you know what I'm talking about, when you have admissions, discharges, pt procedures, pt's going bad and being transferred, and those kinds of things happening all at once), I've noticed that the stress is almost unbearable. I feel like I am going to explode on the inside at times (I'm not talking about an outward outburst, I just feel a horrible turmoil on the inside). On the days so much is going on, I feel very inadequate as a nurse because I feel there is too much going on that I can't keep a handle on it. I am actually, a good nurse.

Our patient ratio ranges anywhere from 5 to 7, rarely 8 to one nurse. Our patients are such high acuity sometimes and we do have many unruly patients at times.

I have, at times, gone to our assistant unit manager telling her of my stress level being very high during the times it has been, and she has always been understanding telling me to take a break. However, the other day, I had a horrible stress filled day with SO much going on, I felt I may crumple up in a corner somewhere and start crying or screaming or something. I just felt so overwhelmed all day long. However, I always manage to take care of my pts, get everything done, and manage to leave somewhat on time. I still don't feel good about my days work. Anyway, I talked with my husband about it on this horrible day and I told him I don't think I can go on working like this that the stress level is so high I don't think I can bear it anymore. He was very understanding and said whatever I have to do, we will do.

The next day on the way to work, I felt as if my body and mind had been in some kind of war or something. I took report, but didn't feel right. I saw a couple of patients, until my manager came in and I told her how I felt. She told me that I needed to see a doctor, which I did. She took me out of work for a week, put me on an antidepressant, and made an appt for me to see a psychologist. I told my unit manager this and she was very understanding and I got the papers for a medical leave. My appt with the psych is in a few days.

Right now I feel better, but that is knowing that I don't have to go back to work for several days. The med has me feeling a little jittery and restless, but at least I don't have depressing thoughts. Now I'm here at home trying to figure out where I want to go from here. I don't know whether or not to try the hospital again after my rest, new meds, and appt to the psch, or try to find something else. Something else in this economy will be hard to find, and even so, I don't know where else I would want to work. I got really sick of home health care nursing....so I don't want to go back to that. MD offices are also horribly stressful I would think.

Our finances are good, we have most of our bills payed for, one child married, but one child in college which we have to pay 12 K a year for (she had a partial scholarship). If we really had to, we can afford for me to not work for awhile. But during that time, I would lose my experience, and you have to actually work as a nurse to keep your license up. So I am left pondering some deep questions. Can I really take this anymore? And if I can't, what now? I hate to lose what I have worked so hard for, but I want to live also and not have some mental breakdown, which is what came so very near to happening. I have not adequatley described the horrible way I have been feeling and my anxiety level. But suffice it to say, it was unbearable. I have thoughts of this world being horrible, nothing good in it and all kinds of things.

I can tell everyone I worked with is stressed too, so it's not just me, but I'm the only one that it has affected in this way

Words of wisdom from anyone? I'm kind of tender right now, so please be gentle. :)

[leslie :-D]

my very first thought, was that you may be perimenopausal.

i think maybe another md visit may be in order, just so s/he can draw levels.

if you are, there are treatments to help your symptoms.

and i also think going to part time/per diem, would be very helpful and cut down on a lot of the stress.

find an activity/exercise you enjoy, and work it off.

be extra good to yourself, these next 5-10 years.:)

be well, my friend.

this too, will pass.

i'm glad your husband is supportive.

that always helps.

leslie

[Kosmonavt]

At the place where I work, per-diem is not an option anymore. Before, they would ask you to work an extra shift every other day, but nowadays even full-time employees are getting called off. I'm lucky that I'm in California where we have ratios, but even taking care of 4 patients on my med/tele unit can be stressful and frustrating at times. If I had to take care of 6-8 patients I wouldn't be able to withstand it. The money at my current place are good, but I want to get over with the hospital nursing. You quit the home health to work at the hospital, and I'm going to do the opposite. :icon_roll

[BerryHappy]

May I be so rude as to ask why you left home health? I am considering leaving LTC for homecare simply because of the pt load and politics. I LOVE geriatrics but I don't think I can handle the nurse eat nurse thing. Why'd you leave home health?

[inthesouthrn]

BerryHappy, I left home health because I got burned out in a way with it also. The work load was much easier, but seeing the home environments and going to bad locations got really old after about 10 years of that.

[ksangel]

be sure to have your dr check a thyroid level as well

i went through a lot of extreme anxiety, stress, and depression symptoms. all related to my uncontrolled thyroid level. i still have times that i am down or "blue"...but not enough for meds. and usually someone can easily get me out of the mood. but after the thyroid was removed and they finally have me on the right amount of medication. the whole world looks different.

i am returning to nursing after a 2 1/2 year hiatus. i am nervous and scared at same time. i dont think i want to work fulltime. my b/f does pretty good at providing for us. like the idea of choosing when i want to work. that just may be a good idea.

i have taken a lot of continuing ed hours. and am planning on getting some books as well. not alot has changed in 2 years. but i want a refresher. the main concern is the new meds.... for pain and diabetes. they change so fast it seems. i was a lpn in an assisted living unit and also worked on the skilled nursing unit in the facility.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I have discussed this ad nauseum on here,...only because I'm so passionate about it,...so those of you reading this for the 334,678,946th time might want to skip this one....

I've been with the same hospital for over ten years now. I spent 8 yrs on a very busy tele unit. I often had 9 pts while charging. I was frustrated about being expected to care for too many patients, teach others and keep up with all the "busy" work that seemed to double every three months or so. I loved my coworkers, and loved being a nurse so I decided to stick it out, be more involved and try to change things. I was having trouble sleeping during the day (I worked 12hr noc shifts) and at one point I was taking 20mg of Ambien, and a glass of wine just to get 5hrs of sleep. (Very BAD idea, please don't do it!) I had chronic GI issues, carried a bottle of TUMS in my pocket that might last through the week. Of course I saw my family doc,...maybe I'm depressed, maybe it's IBS,...had all the work ups, started on all the GI meds and Effexor.

I found myself crying at work, and dreading going to work, but I'm not a quitter and I could make a difference! This lasted close to 3 yrs!! Finally one really bad noc, I was charging, precepting a new grad (who was with me, and wasn't allowed to have an assignment of her own) and had 2 other nurses who were less than 8mo out of school. We had one aide and no secretary, and 30 patients. My two new grads were doing their best to care for three pts that really should have been in CCU, but CCU had no beds. The house supervisor came to me at 0100 and said we had an acute MI that was "stable" in the ER and we were getting the admit. I very calmly explained our situation to her (which of course she was aware of) and said that unless she could send us a fourth nurse we could not take the patient. She became angry and informed me that she wasn't asking me to take the pt, she was telling me that I was getting a new admit. I again calmly told her that unless she found us some help, I would not take report and accept that pt. She then turned to the resident who was at the nurses station and started talking about how much she hated nurses who acted like they were the only person in the hospital who was actually expected to work while we are here and how being a team player would make the whole hospital environment better for all of us.

I lost it,...I was sooooo angry. I did raise my voice,..I didn't swear,...but I did tell her what I thought of her and reminded her that she hadn't once been on our unit to help with and admit, hang some blood, or even start an IV! She couldn't even answer the darn phone while she stood there waiting for someone to explain to her why there wasn't any coffee in the waiting room for our families who are visiting! I didn't get the admit, and I met my unit supervisor on her way in that morning. I sat in her office, exhausted and so very angry. I cried, which made me even more angry and I told her that I couldn't come back and do this again. She did calm me a bit,..gave me the next two days off and asked me to really put some thought into this before I "burned bridges".

I slept for two days, then had an interview on the third day. I was hired on the spot and because it "was the right thing to do" gave my boss 2 weeks notice. I only worked three of the six scheduled shifts during that two weeks and then started my new job. That was a little over two years ago.

I tell you all of this in such annoying detail because I want you to understand how my life is now. I transfered downstairs, same hospital to ER. This is one of two truama centers in an 8 county area and we see 60,000 + pts a year. I haven't taken an Ambien in almost 2 years, the diarrhea is gone and I only vomit when I get the occasional stomach flu, maybe once a year, or eat the chicken in the cafeteria, which I just don't do anymore.:icon_roll I'm not taking any GI meds and no more Effexor. I take an occasional Ultram for back pain and probably drink too much caffeine.

My co workers laugh at me when I say the stress level in the ER is nothing compared to my previous unit. It is very busy in the ER. It is very fast paced, and you are never really done, BUT the important part here, is that we have staff! We work well together, we do what we need to do, the next shift shows up and we let them take over where we stop. I almost always get out on time. If I'm exceptionally stressed, my co workers notice and send me for a walk. If I have an issue with a doc, a co worker, a policy or whatever, someone listens to me! If I have an unusually rude pt or family member or even another doc, our docs step in and firmly explain that they aren't allowed to treat his/her nurses that way!

My job is in no way all roses and ice cream, we have our moments, but overall this is a great place to spend 12 hours of my day. My point here is that maybe you just need to find the right job! Could you float for the hospital for awhile and "try out" different departments? Of course if you can afford it, working part time or prn would be a great way to stay out of all the unit politics, but wouldn't really help with the under staffing issues. Ask around and find out what others have to say about different units, find out the best place to work.

Take care of yourself first. Love your husband and take advantage of the support he offers. Hopefully you will get well rested and be able to find a "good fit" somewhere where you feel supported and part of a team that actually makes a difference during a shift! Best of luck to you, you will be in my prayers!

[inthesouthrn]

Thank you so much everyone for the great advice I've received here. It has helped so much.

A few weeks ago I found out there are not many openings in the hospital, and what was open were depts I really didn't want to go to that I heard were worse than what I already have. So far since I've been home on my medical leave, the very thought of returning to the floor gives me that deer in the headlight feeling. It's almost unbearable and I don't know if I can do it. I keep seeing in my mind my med cart at the beginning of that circle hall and everything that it represents, a symbol of the day to come. Creepy sounding huh?

Sigh....I just don't know what to do still.

[neatnurse30]

I do too work PRN and it does wonders to the body, I can choose when and how many hours per week I can work. And I get paid more and don't have to ask a manager for time off. I would suggest you do that. If I would get stressed out to the point, that I have to seek psychiatrist and be on antidepressants, I would quit the job, period, because my wellbeing is very important to me. I would also let your child take the student loan, or send them to work part time or during summer. Kids nowadays seem to be so spoiled and expect too much from parents, I went to private school and paid along the way cash, working hard, why your kids can't do that?

[Keepstanding, ASN, RN]

ahhhem.......school nursing has it's own set of stressors going on.. so consider this as well.

praiser :heartbeat

why don't you try school nursing ?

[inthesouthrn]

Neatnurse, my youngest daughter, who is in her first year of college told me last night (when I told her the problems I'm having) that she would do anything it takes to help. She said she would work part time, get a job in the summer, just anything she could and that I need to think about myself and my wellbeing. She is an extremely wonderful person and light of my life, so, yes, there are options there. I agree, some kids are spoiled and ask for everything and think only of themselves, but not this one. I appreciate your message, as well as all the others too. I agree with you. Any job that makes you have to go see a doctor, then psychologist, and be on an antidepressant is a job I need to get away from. I'm just still trying to figure out what else I can do.

[inthesouthrn]

I appreciate all the great replies to my thread "Stress related near breakdown." They have all helped so much. At this point I'm on day 3 of my 8 day medical leave. I'm still having a great deal of anxiety when I so much as even think about returning to the floor. I am very seriously considering taking an extended time away from nursing. Maybe 6 months to a year. I have some questions though. Doing something like this could have a great impact on my future nursing career. I doubt I would ever go back into a hospital setting, but when I do apply for a job, what the heck am I suppose to tell a potential employer? "I'm sorry, I almost went insane during my last job, but I won't do that again." And for that matter, what about your nursing license, don't you have to actually work a certain amount of hours to keep it up, and would I have to take a refresher to get back in.?

My gosh, it makes me stressed just thinking about all the problems taking a long break would cause, almost as much as the thought of going back to the floor. I'm just in a mess......that I just can't figure a way out of.

[classicdame, MSN, EdD]

Why not try an MD office or school nursing or health dept or---- All jobs have some stress, of course, but individuals vary in what they can tolerate. I would not tell them "why". Just say the scheduling and environment did not suit you. Say you learned a lot and know that will go with you wherever you work. Then change the topic to talk about what you can do for them.