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Think I'm on the road to burnnout already... VENT... sorry so long

Posted

Specializes in PCU/Telemetry.

Well, I've only been an RN for a little over 6 months now and I am not sure I made the right choice by atarting this career. I work night shift on a PCU/tele unit, generally we have 5-7 patients each.... I feel like from the moment I walk in, I am constantly running to keep caught up, passing and pushing meds like a robot, no real time to spend with my patients other than the quick assessment. I went in to nursing to help people but most days I don't feel like I am. I still feel like I don't know what I'm doing.

Every day is worse than the next it seems. For example: last night I walked in and this was my assignment: Patient 1:had been on the unit for 3 hours (admission not yet done) all they had done on the patient was take vital signs Patient 2: Confused elderly woman in posey vest with angry family that want pt discharged NOW Patient 3: Pancreatitis with uncontrolled pain/ nausea/ vomiting whose BP had been over 200/100 all day not addressed by doctor Patient 4: Gross hematuria with q 2 hour bladder irrigation Patient 5: Isolation for c-diff Patient 6: New onset Afib on cardizem drip. So how do I even prioritize here. I call on the BP/pain first. Orders to start a PCA. Do that. Come back, family of pt 2 at desk yelling. I calm them down, call MD, he agrees to discharge. I do her paperwork remove iv, tele, etc. Walk her out. Come back in to do admission that has not been completed by days. Call from desk that patient 5 has pulled her IV out. Gown and glove up to start new IV. Back to admission. Finally finish admission. It is now 9 pm and I have not seen any of my other patients other than to pop my head in and say hi i'm your nurse, i'll be back. So my charge nurse comes up and tells me theres a transfer from ICE coming and -lucky me- he will be my patient becuase I am down to 5 patients now. Just after I get my transfer in and settled, I get an admission from the ER. I finished my assessments and 10 pm med pass by midnight. Patient 3's pain is better but BP still uncontrolled so I call on that again. Irrigate that foley cath again. Midnight meds get passed. Finally start charting by 1 am. Chart checks were done by 3 am. MARS done by 4. Then it was time for I and Os and daily weights, IV tubing changes, Check AM vitals and lab results. Then 6 am meds. Then the MDs start coming in and then the day shift comes in.... I didn't have time to take even a ten minute break off the floor, didnt have time to eat....

I don't know if it's the hospital I work at, the floor I work on, or the charge nurse I work with, but I am heading for burnout fast. I practically jump for joy when I get called off (although I desperately need the money). And now with only 7 months experience I am a precepter for new employees and nursing students (scary) and they have started floating me to ICU. When I told them I wasnt comfortable floating to ICU they said "well nobody is, but we all have to take turns." I am honestly scared that I am going to lose either my licsense or my sanity... maybe both LOL.

This isn't the specialty I wanted to work in, it was what was offered and I took it. I wanted L&D, Mother/Baby, NICU/Nursery, or Peds, but I wonder if it is just as crazy on those type of units... I knew nursing would be fast-paced job, but I wasn't prepared for this...

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

1. What are you doing to take care of yourself? What stress management strategies are you using? Are you taking sufficient time off? Do you get physical exercise regularly? Are you eating well? Are you getting plenty of rest of your days off? etc. If you want to avoid becoming burned out, you ned to take these sorts of things seriously and schedule time for them.

2. At what point will you be eligible to transfer to a unit that would appeal to you more? Part of you unhappiness may well be due to the fact that you "settled for" the job that was offered and are not working in one of your preferred specialties. In your position, I would be actively trying to get a job in the specialty of my choice.

3. Have you identified some people in your work environment you can discuss your distress with? For example ... a mentor, former preceptor, unit educator, etc. Getting the perspective of someone who knows the unit well might help you sort things out a bit. You might be performing much better than you think and just need a little more time to get your time management skills down so that you are not quite so stressed. Or perhaps, they can give you some good advice about how to handle the ICU situation.

Nurse Lulu

Specializes in critical care.

I am so sorry you are having a rough time. I am a nurse with almost a year experience and I think I know how you feel. I felt this way (and sometimes I still do) when I started working on my own. It might just be your unit. If you dread work every da, maybe it is your unit. Can you transfer to another unit? Do you live around other hospitals? If you want to work with kids you should go for it. Best of luck whatever you do. CAT

No amount of "stress management techniques" will address the real problem that you are experiencing: too-high patient-to-nurse ratios! I fear the nursing shortage is a vicious cycle in which nurses will burn out (understandably!), leave nursing, making the ratio even worse and even more conducive to burnout, etc., etc. I fear the nursing shortage is here and worsening because no one is willing to work in such conditions anymore.

My fear is that, no matter how many nursing students we graduate, these new grads will then be flung into the stressful cauldron that is nursing (esp hospital nursning), only to get discouraged themselves and quit. Hospitals may become one big sieve of nurses...

Not to mention the hyper-documentation & charting now required for legal reasons. Hospitals run as big business + perpetual fear of lawsuits do not a sane, or safe, work environment make. And the nursing shortage is the not-too-surprising result of all this.

I also believe that if we now must call patients "clients", the word "nurse" should likewise be changed to something garnering more respect - but that's a minor note compared to the current staffing ratios. More patients = increased mortality per patient added, esp. above four patients per nurse. This has been published.

suanna

Specializes in Post Anesthesia. Has 30 years experience.

You are just ahead of the curve! I know very few nurses that don't hate thier jobs at least some of the time. The wide eyed optimism usualy lasts a year or so before we start to realise what we have gotten ourselves into. I found a job I loved for a few years but with a lot of effort our management managed to destroy the best functioning unit I have ever seen. The best you can hope for is taking the few crumbs of satisfaction you get when you actualy make a difference in a patients recovery and use them to sustain yourself through the long droughts of futility. Welcome to nursing.

MelBel

Specializes in Geriatric, Medical/Surgical.

Your night sounds a little bit like mine...and really, I seem to only have bad nights when I get left with a mess from the day shift. Yesterday day shift had 7 nurses...6 on the floor and a charge. We had 3 nurses on nights (I had 7 pts plus charge). I got there, and found that a patient had "just come up", and nothing had been done with her (not even vitals). Another had come up only a few minutes prior (in the same room), and at least the chart had been done. By the time I saw my patients it was 8:30... (shift starts at 6:30), meaning this new patient had not yet been assessed by anybody. At 9:30 by the time I assessed another patient, who had been transferred up at 3pm, I found that noone had charted on her since she came up. Had a couple of rough families, missing meds, admissions/discharges.

I usually try to not leave much of a mess in the morning, but I feel like since most of us on nights are new, we are taken advantage of. The day shift nurses will run out the door, and leave us sitting in a mess they created. And THOSE are the nights that burn me out! By the time I am close to caught up at 1 or 2am, I have no sense of organization or energy left for the rest of the shift.

Just had to vent :)

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

One thing that helped me was to look around at other options. What I saw was that the place I am now is where I want to be for now. Not feeling "stuck" there helped me to adjust my attitude. The second thing I did was to realize that my expectations of nursing (ie the wide eyed optimism I entered nursing school with) did not match the reality. I no longer go to work expecting to have a smooth shift. I expect things to go wrong; I expect to be overwhelmed; I expect to feel inadequate and stupid. Now, when I have a smooth shift, it's a pleasant surprise and I can enjoy it for what it is.

PatricksRNMommy

Specializes in PCU/Telemetry.

One thing that helped me was to look around at other options. What I saw was that the place I am now is where I want to be for now. Not feeling "stuck" there helped me to adjust my attitude. The second thing I did was to realize that my expectations of nursing (ie the wide eyed optimism I entered nursing school with) did not match the reality. I no longer go to work expecting to have a smooth shift. I expect things to go wrong; I expect to be overwhelmed; I expect to feel inadequate and stupid. Now, when I have a smooth shift, it's a pleasant surprise and I can enjoy it for what it is.

Maybe that's the trick LOL. expec the worst and you'll never be disappointed. Thanks everyone for all of your comments.

awe... being a mom and having gone 3.5 years in nursing school when my kids were 1 and 2 yrs old, I know what you mean! I started to get really burnt out at the end of the 3.5 yrs. I was getting sick all the time too. I had a great (3.8) GPA but I was so tired all the time and I was yelling at everyine at home. My husband said I needed to quit and wait til the kids were much older to go back (like graduating high school). I did leave and it was very hard for me. I loved school. But he was not working when he had to come home and take care of the kids while I was in school. It took me a couple years now to think about going back. I had thought about it before but always with hesitation due to the knowledge that I will have a lot of care plans and studying ahead of me again. I loved it but when you are burnt out, it gets harder and harder. I think I am ready to convince my husband to allow me to go back as long as I can get day hours for school and our kids will be in school. I knwo how it is though, having a family and going to school. It is so hard to "do it all" After I left school, I sat down one day and I honestly could not understand how I found time to do all that I was doing while in school.

Morettia2, BSN, RN

Specializes in CTICU, Interventional Cardiology, CCU.

Wow this sounds alot like my situation at work...actually almost exactly like my situation. I also work on a cardiac step down.tele unit at night and I am on my way to burning out. I get to work get report, sometimes I get 4 pts on a GOOD NIGHT, most of the time I have 5-6 pts, usually one with a femoral sheath, one with uncontrolled BP, one CVA, one with Runs of V-tach, Icd ectractions you name it I get it. Tonight I had 5 pt's, one for OHS in the AM who has been off his psych meds for schizophrenia for over a year, one for PTCA in the AM, a s/p heart transplant that trashed the heart due to IV drug abuse on w/d precautions, a pt who I tranfused the night before that is a complete with uncontrolled a-fib and a s/p PTCA with an angioseal that was oozing. OK so I priortize and at 5:30 AM I am preping the pre-op pts. and the chrage nurse tells me I am getting an ER NSTEMI with major CHF exacerbation...the charge forgot to tell me the pt. dosen't speak english..ok that I can handle cause my girlfriend I was working with speaks fluent spanish..but I look up at the N:P ratio and realize that there were 2 other nurses that could have taken that pt. I said I have 2 pre-op pt's one who is going for OHS in 15 min and a groin that has been oozing all night and just stoped. I asked the 2 other nrses to take the pt. they ignoed me and took a 1.5 hour break just so they didn't have to accept the pt. At this point my BP was probably sky high cause I was so mad. I took the ER report admitted the pt., with a smile on my face. Chck on my other 5 pt's and they all told me what a wonderful nurse I am and how I made them feel like a person and not just a burden, OK that made me feel alot better and made me smile, soo I am giving report and after I am finished I realize I am the only one let from night shift still there..I said what time did the other Night Nurses leave, my girlfriend said about 45 min. ago, and why did they give you 6 pt's when one of them could have taken the pt, and you all could have been out of here on time. I just gave my girlfriend the look...she laughed and said oh I now what you mean. I didn't open my mouth and I didn't say anything. My old preceptor, who is like a sister to me, took me aside and said U need stick up fpr yourself and not let them take advantage of you, you are a great nurse and your patients love you, as for the Nurses who left early their pt's are very upset with the quality of care that they were given and asked for you ( I have had the other nurses pt's in the past)..she went on to tell me that The pt's said that they saw the Nurses maybe 1-2 times a night if that, and most of them didn't didn't recieve the care they needed...this sort of thing only happens when I work with a certain crew of people...I mean the other night I was in the middle of a code which I asked for a code to be called 3 times and was ignoed, it was only when my girlfriend on the other side of the unit which is huge ran over and said to the same crew I was with last night, what the hell is wrong with with you guys she is calling for help and you are just sitting there, this pt is in respiratory failure...CALL A CODE NOW..while in the middle of the code which was at 5am the charge nurse comes in and says u are getting an ER admitt as I am bagging the pt and we are pushing all kinds of meds..my girlfriend took over....I turned around took the papers put them on the desk and said I am in the middle of a CODE have one of the other nurses take the pt comming from the ER b/c they have a 4:1 pt. ratio..I was at 5:1 at this point....the chrage looked me huffed and puffed and walked away..I just need some advice on how to handle this situation I am stuck in..

ukstudent

Specializes in SICU.

Morettia, you need to learn the word NO. You did it the other night, but it shouldn't take being in a middle of a code in order to say it. Your old preceptor is correct, you need to stick up for yourself. Because, they will keep on walking all over you, until they learn that they can't do it anymore.

To the OP, PatricksRNMommy, how are you doing now. This post is about 3 month old. Are you still burnt out?

I was battered so much as a new grad that I left nursing after 2 yrs. of in-and-out of different hospitals. I used to leave the OR where I worked and would literally be shaking in the parking lot from the abuse of mainly co-workers and preceptors. I even had doctors taking up for me , if you believe that! Every new job I had had new problems that were as bad or worse. I was forced back into nursing in 02' after being away for 4 years-my wife lost her job and we had our first child. I've been trying to leave again for the last 6 yrs. but i"m caught in the money trap-at home wife with 2 kids now. I literally feel like I've lost 15 yrs. of my life and I can't get it back now. I'm stressed out, sick all the time, can't focus or remember anything, can't enjoy anything. I basically don't have a life. Six yrs. of college and 15 yrs. of my life gone and I'm mad as hell! I wish I could see one of my instructor's now :angryfire

november17, ASN, RN

Specializes in Ortho, Case Management, blabla. Has 9 years experience.

I don't know what advice to offer...

but,

I feel your pain.

Scrubby

Specializes in Operating Room Nursing. Has 6 years experience.

Sounds absolutely crazy!

I have suffered job burnout a few times and my only advise here is you might need to take some time off for the sake of your mental health. If your workload is that bad that your not able get a meal break, maybe you should speak to your occupational health and safety department. I don't know how a nurse is supposed to provide care safely without adequate food intake. I know i would be either demand a safer working environment or be looking for work elsewhere.

One of the things i experienced when i was new to nursing was being given a bigger load than the more experienced nurses and all the new admissions and discharges. This happens in a lot of places i have noticed because your so new and eager that you don't realise it's happening and when you do catch on, you feel powerless to act. I realized what the other nurses were doing and made it very clear to them that if i'm not given a fair workload, the nurses union would become involved and i would start writing incident reports about unsafe work practices that were compromising patient care. I was unpopular for a while but my workload was more reasonable.

And at the end of the day as a Registered Nurse we are patient advocates and we should speak up about unsafe patient ratios and staffing levels.

Morettia2, BSN, RN

Specializes in CTICU, Interventional Cardiology, CCU.

I opened my mouth tonight and it worked...I had a pt. that needed the ICU badly and they were ready to give me another and I said NO...amd it worked what a relief!! thanks for the advice all!!!

Morettia,

Oh my goodness! I think I would want to quit!! The people you work with (the majority of them) sound horrible and lazy. What an aweful situation. Is/are there other good places to apply for a position?

Have you ever read the books by Echo heron? She worte books on when she was a student nurse and then after she graduated and she cracks me up! She has gone through similiar situations and she dealt with it in funny ways. Sometimes she just wanted to strangle people (including the doctors) These books are true but the names are changed. She writes them in such a way that I just can't put the books down. Condition critical, is the first one I think. They are so worth the time to read. They are easy too. I think you will gte a lot of insight from her experiences.

all i have to say is wow to ur nights........ i feel like for me day to day its different one min i hate it the next min i have an awesome day where i really feel like i made a difference.... but i willt ell u that as a new nurse 8 mos they tend to kind of like "haze" the new nurses.... which seems like u get the harders pts and admits etc etc..... of course i want to learn and see different things but now while i have 5 pts goin on 6 and u have 3 no way.... i used ot be nice i really did haha but now i stick up for myself and ask why am i gettin them im at 5 they ahve 2 d/c and will be at 3. it usually works they dont expect u to speak up and when u do they dont know what to say hahah..... so if they kniow that u know what the floor is like and it IS possible for someone else to take the pts then say it....sometimes i have awesome nurses aides that can orient the pt to the room while i get caught up most of the time we dont tho its suposed to be team nursing truthfully but it seems like u know who u can ask for help and who will sit on their ass while ur runnin ur ass off... i dunno if its nursing or jus every job, when ur in it for u go to work and do u ......dont take on other things u cant handle say NOOO in the nicest way possible haha good luck!!:bugeyes:

one more piece of advice....... its really helped me VOLUNTEER to take the enxt pt early in ur shift that way ur full:) then u have things done early and ahve all day to do it so that when someone comes in postop an our bf u leave ur already full :) plus they love love when someone takes initiative and volunteers good luck

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