31 replies to this topic

[ResearchRN0704]

Hi, I am an RN, completing my master's degree. I am curious as to whether you were fully prepared for the stress of nursing. Many nurses indicate that they did not really get a feel for nursing, e.g., not that many patients, not that many days on the clinical floor, etc. during nursing school. Then, wham, out into the real world. Have any of you felt like getting out of nursing because of stress related issues?

[Holly_RN]

Yes....Because I did my "training' in the dark ages, under the hospital based system. It was a three year programme and you were in charge of a ward from your second year with an RN on the other side. We carried a full nursing assignment - in fact students played a large part of "staffing" the hospital. All for 15 dollars a month plus room and board. Now college/university grads at the same hospital have a six month "orientation" before being given a full assignment. We aren't comparing the same thing though because the acuity of the in-patients has risen. It use to be (before IVACS etc) that two patients on the ward with IV's made a busy night. ( I still remember counting the drips) Now a patient with only two IV's is a lucky assignment. Of course, back in the 70's many of the antibiotics were given IM.

[EDRNINCT]

I had worked as a CNA and as A Unit Clerk. . .I expected to work hard. . .somehow things have changed dramatically in the expectations though since I became a nurse.

[ladybugj]

I actually thought I was fairly warned what nursing entitled because my mom is a nurse and probably the hardest worker I have ever known. We always discussed nursing and her job at dinner...Then came nursing school, the clinicals were for only 5 hours spent on the floor and 3 for pre and post conference, once a week. I was enlightened when I began to work! It is so much more stressful. The long hours, the emotional toll and the patient to nurse ratio's are almost unsafe. When will this change? When will we put people before politics?

[lberghood]

hello i have been an rn for 17 years, i graduated from a diploma program and was fortunate to have been exposed to a lot of clinical experience before i graduated and still found the transition from student to "real nurse" extremely stressful. I was fortunate that my first job beleived in preceptors and i was given an extensive orientation. Even with that, there still is the reality that you are no longer the student and are ultimately responsible for the patients that you care for. Over the course of my career i have had many jobs and have been fortunate to be in the position of overseeing nursing students in home health and psych. I make it a point to discuss these issues with them and aknowledge their fears and insecurity. I also witness staff who seem "annoyed" by students and the students feel as if they are in the way. In some ways working is easier than being a student. I realize that nursing is an extremely stressful job and taking the time to help a student when you are overworked yourself is no easy task but i feel that one of the best gifts we can give to our profession is help create better nurses who are more secure in their roles and know where to find support. I feel that overall as a profession, we are getting better at not "eating our young" but given the stress of what we do it is something that we all need to be mindful of. I am currently in my first position as a supervisor, i had never felt that this was something i would want to do but i found that i really enjoy it and look at my staff as my "patients" and try to nurture and coach them so that they are able to do their best. It can be very challenging and rewarding. I have decided that i really want to go back to school and further my education and possibly teach nursing at some point. Any suggestions would be appreciated.

[mattsmom]

I was well prepared as a diplopma RN 28 yrs ago. The real stressors in nursing have come about over the past 10 or so years with the push for hospitals to make profits. Since then, my work environment has become much less supportive; with nurses having to struggle to get what they need to provide safe care. To me, THIS creates MY stress in nursing. The constant struggle and lack of support.

I'm fortunate to be in a good facility right now, with good managers and safe ratios. Where I practiced for the past 25 yrs (down South) nursing was extremely difficult; detrimental to mental and physical health. Units were snake pits with dysfunctional nurses attacking one another; departments were infighting constantly due to the stress and dysfunction. I finally burned out and needed to take a year off to regroup.

I feel for today's new grads and wonder if their schools really are preparing them for what they may encounter. Facilities out there run the gamut between excellent and hellacious and I hope the instructors are giving the students a heads up.

[3boyzmom]

I knew it would be stressful. I never minded giving 110% of myself at work. In fact there was always something kind of exhilarating about working a 'wild' shift and at the end thinking "wow, I did it!" You definately felt needed, and worthwhile, and as though you made a difference.

I agree with mattsmom that it's changed in the last ten years or so, though. The push for profits have caused serious understaffing (OK, a nurse shortage is surely also to blame, but even so, the hospitals staff with the absolute minimum of staff for $$$ reasons). I don't know how they do it now, but there used to be grids the supervisor used ("x number of patients, gets x number of nurses.") It didn't take acuity into account. Later, different grids were developed that said "x number have IV"s; x number have treatments, etc." Seems like this would help, but it still doesn't give an adequate picture of what the floor is like. (It doesn't take into account that there is one patient who requires that a nurse be in his room almost the entire shift).

Also, the thing that really caps it off for me, is that the environment has turned so litigious. It's always in the back of your mind "cover myself", when it used to just be that you did the best job you could and knew that people were human, and as much as we'd like to think otherwise, unfortunate things happen once in a while. Now, anytime there's a bad outcome with a patient, you tend to rack your brain thinking "is there any way this can be blamed on me?" Maybe I'm just paranoid (I really am, I guess) but that takes all the joy out of it for me.

Top that off with the many ways that the healthcare industry increases the chance of bad outcomes (premature discharges- poor staffing, etc.), and it's a recipe designed to keep you on edge.

Lastly, acuity is so much higher than it used to be. Like someone else said, in the late '70s, you'd have your group of patients, and one or two of them would have IV's or be total care. Now they all are. They have to be pretty critical to even be in the hospital anymore.

Of course, this could start a whole new topic about how the abuse and mismanagement of insurance funds years ago have led us to this point- people kept in the hospital way longer than necessary; people admitted for a week 'for a physical', people admitted who could have been treated as an outpatient.

Yes, I think it's far more stressful than it used to be.

[mattsmom]

Yup...you nailed it on the head 3boyz! I remember when women would come to medsurg 'for a rest'. Now, medsurg units are full of patients that would have been in ICU 20 yrs ago. I stay in ICU now knowing I will get the least numbers of sick patients to worry about!!!

True that I never worried about lawsuits like I do today. People 'taking notes' and blatantly looking for lawsuits were unheard of 20 yrs ago.

'Patient experts' and their increasingly demanding family members..these increase my stress as well. Open visiting and the 'customer service' line of thinking now makes it more difficult for me to even TRY to control my environment of practice and reduce SOME of the exogenous stress of huge numbers of people circulating and making demands...UGHH.

Something that stresses me is the rapid turnover. Patients are expected to be stabilized and moved out...rapido!! Now its not unusual for me to have a patient in my ICU just one shift. The admission process paperwork along takes 3 hrs or more. and I'm expected to complete beaucoup teaching and standard of care paperwork, while trying to squeeze a little patient care in. (sigh)I frequently have several at once going on..and feel like a nurse to computers and paperwork instead of human beings.

Well better stop...I'm getting stressed talking about my stress...LOL!

[3boyzmom]

Good point, with the "customer service" framework that exists today.

Of course- the point was ALWAYS to take the best care possible of the patients. But now, we've shifted the idea from "we are professionals here to help you" to "we are dangerous idiots who can't be trusted, so you'd better keep your eye on us at all times and keep us in line."

Ambulance-chasers constantly remind and warn folks to "watch out for those people who work in hospitals and call us immediately at the first sniff of something wrong."

I remember many years ago a man who choked on some food and died. He was eating alone in his room. When the nurse found him, she called a code, and everyone did their very best to save him, but unfortunately he could not be brought back. Now, that is sad and tragic. Everyone felt truly bad about it. But that's exactly what it was- a sad and tragic accident. We didn't go home that night terrified that we'd be called onto the stand in litigation- that just didn't happen that often. You just did the very best you could.

Today, imagine the same scenario. You'd be in court so fast- "why was the patient left unattended to eat, nurse nancy?" "well, he was considered stable, sir, and it is not unusual for a patient to be alone for an hour before the next rounds." "well, obviously, nurse nancy, he was not stable. you should have predicted that this man, who had been eating meals independently the entire time he'd been in the hospital, would suddenly experience a freak accident."

We all have horror stories from years ago. Unfortunately there continue to be some- but as stressful as they used to be (I went home in tears when we lost a patient) your focus can't even be on having sympathy for the patient and the family anymore, because you're too afraid of them!

One thing that chaps me is the "being tired and overworked is not an excuse for an error." PUH-Leeze???
Working a 16 hour shift, because you've been begged to, after you've already worked 3 12-hour days, and you can't even think anymore, but you know that they're truly desperate so you cave into pressure- your mind is numb by the end of it- no excuse? Sorry, it's a recipe for disaster.

I personally don't do that anymore. I won't even work 12 hour shifts anymore because it just doesn't work for my family. I was lucky enough to find a clinic job with weekends off (yes, I know how lucky that was and that not everyone gets that option) and I TAKE them. Some of our nurses in the clinic have weekend jobs elsewhere- working two weeks straight without a day off, etc. Not me. Not worth it. I work hard when I'm there- I figure I "belong" to the hospital and will do everything I can during that time- but after that, I'm on my own. I get my rest, do things with the kids.

Speaking of recipes for disaster- taking a nurse and making her work in an unfamiliar area where she's not comfortable. Simple, just run 'em through a little inservice once a year and they're competent to work anywhere! Then, after the nurse TOLD you that she's afraid to work this area, that she hasn't done this particular kind of work in ages and doesn't feel competent, and she makes an error, no one can believe that this happened! It's happened to me before (thank God, no bad outcomes), getting pulled to ICU ("don't worry, we'll give you the easy patients." Easy patients? In an ICU?) Or, after working 18 years on psych, the department was closed. I went to work on peds, and got a very good orientation/preceptorship there. I can't complain about that. BUT, one day I go to work and find that I'm pulled to med-surg- these adults are entirely different from the kids, and WHAT????? I have to give blood????? Yes, I have done it before- 20 years ago!?!!?!?? As I said, I was fortunate, no bad outcomes. But frankly, this is one of the many reasons that clinic nursing appeals to me. And it's not without its stresses, but it's not as bad. Personally, I can't wait for retirement. I'm tired!

[aussie-margaret]

I trained in the mid-1980's in Westmead Hospital in Sydney - very hard work - $4.50 an hour roughly - the place was so shortstaffed and student nurses did the bulk of the work I am sure.

my first ward was so heavy - old fat diabetics made for hard work.

Where I work now, we had a dressing inservice yesterday - lecturer mentioned as obesity and diabetes continue to worsen, to expect more hard hard work.

I cannot work on the wards anymore. I can't do the heavy work, showering and bedmaking anymore, or put up with stupid people and their rude relatives.

Back to Emergency for me, patients have to be out in under 8 hours, or management is on the phone wanting to know why.

[emma]

:( Hi, I am an RN, completing my master's degree. I am curious as to whether you were fully prepared for the stress of nursing. Many nurses indicate that they did not really get a feel for nursing, e.g., not that many patients, not that many days on the clinical floor, etc. during nursing school. Then, wham, out into the real world. Have any of you felt like getting out of nursing because of stress related issues?

[emma]

Oh yes, yes.. YES. I am going through a dilemma and transition now due to sheer nursing stress. I tried so hard and would start out on the job feeling positive and great. I have come to feel I am not capable of processing all the demands and expectations. I know too that somehow alot of nurses that are making it work are using shortcuts and not following through the way we should be. I am speaking of nursing home context. I am Geriatric certified, I love working with the elder populatin, but the nursing home scene has left me disheartened, sad, angry, confused, and worried about our old folks. I am considering moving in with a relative just to take stock and possibly go back to school for something else. Its like the nine hundred pound elephant in the room and I feel like I am the only one that sees it, or maby just cant deal with it? I would love some responses.
Emma

[emma]

Oh yes, yes.. YES. I am going through a dilemma and transition now due to sheer nursing stress. I tried so hard and would start out on the job feeling positive and great. I have come to feel I am not capable of processing all the demands and expectations. I know too that somehow alot of nurses that are making it work are using shortcuts and not following through the way we should be. I am speaking of nursing home context. I am Geriatric certified, I love working with the elder populatin, but the nursing home scene has left me disheartened, sad, angry, confused, and worried about our old folks. I am considering moving in with a relative just to take stock and possibly go back to school for something else. Its like the nine hundred pound elephant in the room and I feel like I am the only one that sees it, or maby just cant deal with it? I would love some responses.
Emma

[3boyzmom]

No, you're not the only one who sees it. I stay in nursing, though, because I've already been doing it so many years that I don't want to start over in a new career; plus, I don't know what else I could do to make the same amount of money, which I hate to say is a factor, but it is, raising 3 kids.

There are some things that keep me in it besides that, though. Every day I have the opportunity to make someone feel heard and understood; or to give a hug or some other act of kindness that makes someone feel less alone. (of course I knock myself out doing it and put up with all manner of irritation, but nonetheless I do get those opportunities).

I don't work in the nursing home setting for the same reasons you describe. I'm not proud of that; turning a blind eye to something certainly doesn't fix it or help it. But I always feared that I'd be far too overwhelmed and depressed working in that area. Our elderly folks need a lot of time and 1:1 attention, and neither Medicare nor anyone else is going to pay enough to allow the number of staff that would be required to provide really good personal care, the kind that would make the residents feel loved and comforted. I believe that most people who work in nursing homes are loving, good people. But the system is so bad that no one nurse has much control over the situation.

[mattsmom]

I believe all nurses graduated with high ideals..then got out into the 'real world' and had to do some soul searching (and major attitude adjustments) to survive. Finding as niche can be the difference between making or breaking it as a nurse..finding that area that you enjoy is paramount. Taking care of ourselves in a system that uses and abuses us is also a necessity. I needed a year off recently to regroup, from nursing as well as life in general; and am now in a better place in all aspects of my life.

No Emma you are not the only one. My experience is many nurses are like ostriches...many more just flying under the radar and afraid to say anything outloud. Many come to work and just try to get through unscathed. Its a crazy system we work under. We have all this responsibility and so little authority! What a recipe for burnout.

Interesting discussion.