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?
Full Version: Were you prepared for the stress of nursing?
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?
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.
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.
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?
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.
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.
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.
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.
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.
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!
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!
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!
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!
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.
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.
QUOTE(ResearchRN0704 @ Aug 29 2004, 08:24 PM) 
:( 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?
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
QUOTE(emma @ Apr 8 2006, 12:58 PM)
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
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.
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.
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.
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.
I guess I thought I was as prepared as I could get at the time (12 years ago). Today, I would never encourage someone to go into nursing. If anyone asks me about it, I tell tham the realities good and bad. Even now, some days I just stand back and look at what I am doing and think, "Is this REALLY my job???"
I really think I could like a life where I did not know soooooo much about sick people. It is amazingly stressful. You build up a tolerance for illness and for people; a kind of cold distance. You have to in order to do your job. However, you are still expected to be an "angel" with endless patience and kindness. You are the "middleman" IF there is a problem with housekeeping, pharmacy, docs, the food etc. on the unit, well...guess who is expected to get it straightened out. You are responsible for all aspects of patient care- meds, treatments, correct documentation, following up after docs to make sure orders were written, consults were followed up on, and consents were obtained, and still be a kind ear, and a wealth of information wearing a smile. In addition to everything else, you are expected to be on committees, teams and be in charge (plenty of additional work along with your pt. assignment) for the same rate of pay.
It is an emotionally and physically draining profession and some days I wonder how on earth I will do it for the next 30 years. Where I work, we can be mandated. That means a 16 hour day with last minute notice. Talk about draining.
I really think I could like a life where I did not know soooooo much about sick people. It is amazingly stressful. You build up a tolerance for illness and for people; a kind of cold distance. You have to in order to do your job. However, you are still expected to be an "angel" with endless patience and kindness. You are the "middleman" IF there is a problem with housekeeping, pharmacy, docs, the food etc. on the unit, well...guess who is expected to get it straightened out. You are responsible for all aspects of patient care- meds, treatments, correct documentation, following up after docs to make sure orders were written, consults were followed up on, and consents were obtained, and still be a kind ear, and a wealth of information wearing a smile. In addition to everything else, you are expected to be on committees, teams and be in charge (plenty of additional work along with your pt. assignment) for the same rate of pay.
It is an emotionally and physically draining profession and some days I wonder how on earth I will do it for the next 30 years. Where I work, we can be mandated. That means a 16 hour day with last minute notice. Talk about draining.
Yes it's amazing what became our jobs...policing other depts really chaps my hide too. I wish my ancestor nurses weren't so quick to embrace all duties as nursing duties (sigh)
Amazing how sick fat diabetics make up the bulk of our workload world over...LOL!
Amazing how sick fat diabetics make up the bulk of our workload world over...LOL!
What a great topic! I graduated from nursing school last June and just had this type of conversation with another new nurse.
We don't feel we were prepared for "the realworld." The stress on a med-surg floor can be over the top for a well seasoned nurse, now put someone fresh from college in the mix. I don't believe I had enough time as an intern. My preceptor got tired of me asking questions and trying to learn everything I could. I was "passed" around to other nurses - some really good, some really bad. It has taken its toll but I understand why 50% of new nurses leave the profession in the first 2 years.
Someone said new graduates "had to do some soul searching (and major attitude adjustments) to survive" I am a survivor! How long I can remain at the bedside is yet to be seen as I work the 7p to 7a shift. It has been difficult for my family to adjust but as time goes by, it gets eaiser.
I look forward to chatting with other nurses from around the world.
We don't feel we were prepared for "the realworld." The stress on a med-surg floor can be over the top for a well seasoned nurse, now put someone fresh from college in the mix. I don't believe I had enough time as an intern. My preceptor got tired of me asking questions and trying to learn everything I could. I was "passed" around to other nurses - some really good, some really bad. It has taken its toll but I understand why 50% of new nurses leave the profession in the first 2 years.
Someone said new graduates "had to do some soul searching (and major attitude adjustments) to survive" I am a survivor! How long I can remain at the bedside is yet to be seen as I work the 7p to 7a shift. It has been difficult for my family to adjust but as time goes by, it gets eaiser.
I look forward to chatting with other nurses from around the world.
When I went into nursing eight hours shifts were the norm. This gave you time to yourself to recover emotionally if you had a bad day, some time with family or some time to relax with hobbies sports etc. Many more nurses stayed until retirement age. Then we were forced into twelve hour shifts. Soon after that initiation into the longer hours I started seeing my colleagues go part time, retire earlier. Twelve hour shifts are simply too long especially as the accuity and patient load has increased as well. I blame a lot of the added stress of nursing on the twelve hour shifts as it doesn't allow recovery time each of the working days. It has also helped cause the nursing shortage as nurses are leaving the nursing field a lot earlier or going part time.
If I had known what the stress of nursing was going to be, I would never have entered this profession even though I loved my job. I often wonder if the stress that I was under in nursing caused me to get cancer. My dentist once told me that he had just finished reading a study that showed that shift workers' life span is 10 years less than those who have regular daytime hours. The stress to our bodies is enormous and I was not prepared.
If I had known what the stress of nursing was going to be, I would never have entered this profession even though I loved my job. I often wonder if the stress that I was under in nursing caused me to get cancer. My dentist once told me that he had just finished reading a study that showed that shift workers' life span is 10 years less than those who have regular daytime hours. The stress to our bodies is enormous and I was not prepared.
HeatherG, I agree completely about the 12-hour shift issue. I know that it severely limits my opportunities, because I am just not willing to sacrifice my personal life for the 12-hour shift. However, on some message boards where this has been discussed, I found that there are a lot of people who prefer the 12-hour shifts. If it works for them, that's great, but the few short times I've tried it, it cost me and my family a lot. Seemed I was always scheduled to work whenever my kids had baseball games, school plays, etc. Never mind holidays! With 8 hour shifts, even if you work a holiday, you can schedule some kind of celebration around it.
The fatigue that accomanies 12-hour shifts is unbearable for me. Also, with the way most rotations work, you work every other weekend, Fri, Sat, Sun, 12 hours. You might as well be invisible to your family. Then Monday, what- sleep all day??? If not, lay around feeling like you've been hit by a truck? That was me. Then Tuesday was filled with housecleaning, laundry, etc. Then, back to work!
I am not entirely happy with my position in the clinic that I work in. But, it's a hospital based clinic, so I make hospital nurse wages; I work Monday-Friday, and can usually manage to get off early if I have something I have to get to like a school function. So, I grin and bear it, because it allows me to have my own life, more than any 12 hour job. I used to like Med/Surg (or psych, where I spent most of my career) when it was 8 hour shifts. No matter how bad the day was, as you said, you still had time to recover and be with family, or do your own thing.
The fatigue that accomanies 12-hour shifts is unbearable for me. Also, with the way most rotations work, you work every other weekend, Fri, Sat, Sun, 12 hours. You might as well be invisible to your family. Then Monday, what- sleep all day??? If not, lay around feeling like you've been hit by a truck? That was me. Then Tuesday was filled with housecleaning, laundry, etc. Then, back to work!
I am not entirely happy with my position in the clinic that I work in. But, it's a hospital based clinic, so I make hospital nurse wages; I work Monday-Friday, and can usually manage to get off early if I have something I have to get to like a school function. So, I grin and bear it, because it allows me to have my own life, more than any 12 hour job. I used to like Med/Surg (or psych, where I spent most of my career) when it was 8 hour shifts. No matter how bad the day was, as you said, you still had time to recover and be with family, or do your own thing.
:blink hi i am an lpn for almost three years now, and sometimes i dont know what to think. i started out in a nursing home and that didnt work for me because i couldnt stand the stresses of the fighting between shifts and not having enough time in your day to give anyone 1 on 1 attention. the residents loved me and i tried so hard to get everything done. none of the other nurses had any complaints about my work, but i always left there feeling like i forgot something. it has become all about the paperwork. i put alot of pressure on myself because i had always done so well at every other job ive had. i never felt like i was doing enough. i did love working with the elderly. it is so rewarding. however you dont get much recognition from higher ups because everyone is so stressed out. then i moved on to home health care. i am working pediatrics. my patients love me and i have gotton attached to quite a few of them, but i still dont feel like ive found my niche. i am always worried about doing something wrong. i feel like i may need an antianxiety for myself. i have never taken any medications nor have i ever felt the need to until i became a nurse. does anyone else feel the same way????????????????? my mother says i take my job too seriously, but how can you not take it seriously, you are now in charge of others peoples lives. i dont think nursing school has prepared me for the "real world" anyway alot of the girls i went to school with feel the same way. they are not happy in thier jobs. a couple of the girls that got jobs at the hospital are happy and say they love thier jobs. i think i am going to try the hospital because you have a boss and other nursing staff there in case you are not sure of something. i know i had a don at the nursing home, but i usually worked 11-7 and she slept in her office alot. i pretty much ran the floor alone. i am so stressed out all the time and i actually dread going to work. ive never felt this way before. i am a single mother with three kids and i dont want to give up nursing. not only because of the money but because i actually do love helping people. if anyone has any comments or suggestions i would appreciate your help. thank you
anyway alot of the girls i went to school with feel the same way. they are not happy in thier jobs. a couple of the girls that got jobs at the hospital are happy and say they love thier jobs. i think i am going to try the hospital because you have a boss and other nursing staff there in case you are not sure of something. i know i had a don at the nursing home, but i usually worked 11-7 and she slept in her office alot. i pretty much ran the floor alone. i am so stressed out all the time and i actually dread going to work. ive never felt this way before. i am a single mother with three kids and i dont want to give up nursing. not only because of the money but because i actually do love helping people. if anyone has any comments or suggestions i would appreciate your help. thank you
Hi mellie, I'm just flying through and I'll write a real reply later, but I did want to say, in response to a comment you made- you'd be AMAZED at the percentage of nurses who have to have medications in order to cope with their work. (Effexor XR here....) I'm not saying that I might not have needed it anyway, but I know for a fact that the stress and anxiety of my job has a lot to do with it. Just about every nurse that I know well enough to know such personal things about, is in the same boat. Sad, huh.
QUOTE(3boyzmom @ Jul 2 2006, 11:20 PM)
Hi mellie, I'm just flying through and I'll write a real reply later, but I did want to say, in response to a comment you made- you'd be AMAZED at the percentage of nurses who have to have medications in order to cope with their work. (Effexor XR here....) I'm not saying that I might not have needed it anyway, but I know for a fact that the stress and anxiety of my job has a lot to do with it. Just about every nurse that I know well enough to know such personal things about, is in the same boat. Sad, huh.
I can agree with that too. I have been sufferng from depression from stress from work. I went back thinking I am one of the few on medication. Then people kept coming to me saying do not worry we have had to get this sort of help for the job too. Its about 50% of the staff that I know of now. It seems the untold story of our job's stress is a bigger problem than some like to admit to the public.
we started 10 hour nights in my emergency dept on Wednesday
my first was last night - and it was a long night too
another night tonight
I have never seen 12 hour shifts but I know intensive cares and some private hospitals offer the 12 hour nights and shifts
no thanks - too long - why drive yourself into an early grave for somemone else, who most likely could not care less anyway
I couldn't stand the pts for that long - that's why I like emergency
"meet, treat and street"
I drive the night dr to the railway station in the morning - he does his handover, I do mine - and we are out of there.
and the morning dr is typically late, so if he misses his train, he has to wait one hour for another - how rude and thoughtless is that.
my first was last night - and it was a long night too
another night tonight
I have never seen 12 hour shifts but I know intensive cares and some private hospitals offer the 12 hour nights and shifts
no thanks - too long - why drive yourself into an early grave for somemone else, who most likely could not care less anyway
I couldn't stand the pts for that long - that's why I like emergency
"meet, treat and street"
I drive the night dr to the railway station in the morning - he does his handover, I do mine - and we are out of there.
and the morning dr is typically late, so if he misses his train, he has to wait one hour for another - how rude and thoughtless is that.
QUOTE(mattsmom @ Apr 9 2006, 07:16 AM)
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.
Hi there
i am new to this discussion and in general new to any nursing discussions. this is because i am a new RN just graduated 6 months ago and working as a grad nurse in a hospital.
i must say i am abselutly amased and shocked and did not expect the folowings:
1 such high levels of stress
2 such little support avaliable (natrually everyone is to busy to support you)
3 such high expectations from a university trained rn
4 such low satisfaction from the work
i must say i decided to be a nurse because i felt i can contribute by being there for people who are not well and going through down time in their life, but i found that hospital nursing very rearley gives you a chance to actually do that (care for people). there is alot of administrative work alot of paper work and phone calls and communications with other health care professionals and trying to find supplies and reading procedures and running around in circles because people ask for things all the time. you cannot focus on your actions or chain of thoughts for longer then 2 minutes becouse someone else want something from you. it is crazy and stressful and makes my head spin. you have to think about 10 things at once, what a recipe for disaster. takes me ages to wind down when i come back home to my family.
also university does not teach you about nursing. it teaches you about diferent illnesses and symptoms and so on but not about how to be a nurse which is so different in reality.
i strongly believe that in nursing due to its demanding, broad and huge knowledge base and its complexities (dealing with many diffenrent people, many diferent illnessess, so much grey areas, hirarchic structure)- it takes a long time to be experianced and to just know what to do (as if it is your second nature). but yet just because you are registred you are expected to have the same responsibilities as any other nurse. this is abselutly unreal and unsafe. how can one be so responsible and know what to do in each situation if they've been nursing for only 3-4 weeks? or even 3-4 months? there is so much to learn before you find your feet.
any way this is a whinge from me
i just feel so overwhelmed by it all
and so dissapointed that there is so little support for grad nurses out there.
i am glad to hear i am not the only one that thinks it is all too much for a working day and for wanting to do somthing good and care for others - and all you get is high stress levels and depression and anxiety. not good at all.
i wish this place had a spelling check as english is not my first language. hope you forgive me for my spelling mistakes.
[font=Arial Black][size=1][size=2]
i am new to this discussion and in general new to any nursing discussions. this is because i am a new RN just graduated 6 months ago and working as a grad nurse in a hospital.
i must say i am abselutly amased and shocked and did not expect the folowings:
1 such high levels of stress
2 such little support avaliable (natrually everyone is to busy to support you)
3 such high expectations from a university trained rn
4 such low satisfaction from the work
i must say i decided to be a nurse because i felt i can contribute by being there for people who are not well and going through down time in their life, but i found that hospital nursing very rearley gives you a chance to actually do that (care for people). there is alot of administrative work alot of paper work and phone calls and communications with other health care professionals and trying to find supplies and reading procedures and running around in circles because people ask for things all the time. you cannot focus on your actions or chain of thoughts for longer then 2 minutes becouse someone else want something from you. it is crazy and stressful and makes my head spin. you have to think about 10 things at once, what a recipe for disaster. takes me ages to wind down when i come back home to my family.
also university does not teach you about nursing. it teaches you about diferent illnesses and symptoms and so on but not about how to be a nurse which is so different in reality.
i strongly believe that in nursing due to its demanding, broad and huge knowledge base and its complexities (dealing with many diffenrent people, many diferent illnessess, so much grey areas, hirarchic structure)- it takes a long time to be experianced and to just know what to do (as if it is your second nature). but yet just because you are registred you are expected to have the same responsibilities as any other nurse. this is abselutly unreal and unsafe. how can one be so responsible and know what to do in each situation if they've been nursing for only 3-4 weeks? or even 3-4 months? there is so much to learn before you find your feet.
any way this is a whinge from me
i just feel so overwhelmed by it all
and so dissapointed that there is so little support for grad nurses out there.
i am glad to hear i am not the only one that thinks it is all too much for a working day and for wanting to do somthing good and care for others - and all you get is high stress levels and depression and anxiety. not good at all.
i wish this place had a spelling check as english is not my first language. hope you forgive me for my spelling mistakes.
[font=Arial Black][size=1][size=2]
Hi Bonie. What is your first language? Are you in the US? I graduated from a 2-year RN program in 1981, so I've been nursing for 24 years. Actually 25, as I was an LVN for one year prior. When I graduated, I had to work in the Surgical ICU as charge nurse- didn't have my license yet, I was a grad nurse- scared out of my wits! I remember walking in one night and there was a man on the "balloon pump" (do they still use those?) after a heart bypass. I had never seen it before. The offgoing day shift said "oh all you have to do is watch and make sure that all these dials stay between here and here." I said "what if they don't?" and they said "Call the house supervisor." Later when the house supervisor was making rounds I asked her about it. She said "I've never seen it before either." Luckily, the night passed uneventfully and all the dials stayed where they were supposed to. I decided then that I would never accept another dangerous assignment like that. How would you like to have been that man's family, trusting me with his well-being? I didn't stay in the ICU long. I wasn't hired as charge nurse; I wasn't crazy enough to do that- what happened is that shortly after I started working there the charge nurse left and there were no other RN's on the shift. I was 21 years old.
And it's pretty much been high stress ever since. If only there were time to get to know your patients a little; to sit with them while they are dying; to wash their hair if it needs it. You're right, we communicate more with other departments and other caregivers than with the patients. And we might as well be strapped to the computer and the charts.
I hate when someone asks me to do something and I say "sure, I'll be glad to"- then on my way to do it, I get stopped by some other crisis- and then driving home I'll remember that Mr. so and so wanted a blanket. It makes me feel awful!
But, I think what you have to realize, is that little moments actually count. A kind word here and there; a hug, offering pain med before someone asks for it because you can see that they're uncomfortable.... these really do mean more to patients than we realize. I was in the hospital overnight recently (first time in my life, except for childbirth) and no nurse sat down or spent any real time in my room to speak of; but still they all communicated warmth and friendliness and concern for my comfort, and it made a big impression on me. Hang in there. It'll always be stressful...but it won't always be overwhelming like it is now. I know that right now you're in the "sink or swim" stage..... but I promise, you'll swim, and you'll be OK!
And it's pretty much been high stress ever since. If only there were time to get to know your patients a little; to sit with them while they are dying; to wash their hair if it needs it. You're right, we communicate more with other departments and other caregivers than with the patients. And we might as well be strapped to the computer and the charts.
I hate when someone asks me to do something and I say "sure, I'll be glad to"- then on my way to do it, I get stopped by some other crisis- and then driving home I'll remember that Mr. so and so wanted a blanket. It makes me feel awful!
But, I think what you have to realize, is that little moments actually count. A kind word here and there; a hug, offering pain med before someone asks for it because you can see that they're uncomfortable.... these really do mean more to patients than we realize. I was in the hospital overnight recently (first time in my life, except for childbirth) and no nurse sat down or spent any real time in my room to speak of; but still they all communicated warmth and friendliness and concern for my comfort, and it made a big impression on me. Hang in there. It'll always be stressful...but it won't always be overwhelming like it is now. I know that right now you're in the "sink or swim" stage..... but I promise, you'll swim, and you'll be OK!
Hi 3 boyzmum
thank you so much
made me feel much better.
i am aware of the fact that those little things count. what seem like such a small thing for us (the givers) seem so much to the receiver, (the patient) as they are in such a needy state.
i dont know. i guess hospital nursing is not for me.
like you say will be good to know the patient more and to see them take more control of their plan of care, their recovery, their situation. i guess i hate the hospital system. where nurses have so much power and the patients are just so powerless and so in the hand of the medical system. the doctors, the nurses, they just lie in bed in a hospital gown and so out of control.
i red this great article someone wrote about vertical nursing (rather then horizontical). it was great.
here is the link to it.
http://impactednurse.com/?p=27
also i think that i have alot of problem with my time managemnet at the moment, dont seem to go home on time. any tips from anyone? i think it is a real skill. and it is somthing we dont learn at uni. i need some tips. please......??
thanks again boyzmum for your great reasuring replay. i am a bit happier now
thank you so much
made me feel much better.
i am aware of the fact that those little things count. what seem like such a small thing for us (the givers) seem so much to the receiver, (the patient) as they are in such a needy state.
i dont know. i guess hospital nursing is not for me.
like you say will be good to know the patient more and to see them take more control of their plan of care, their recovery, their situation. i guess i hate the hospital system. where nurses have so much power and the patients are just so powerless and so in the hand of the medical system. the doctors, the nurses, they just lie in bed in a hospital gown and so out of control.
i red this great article someone wrote about vertical nursing (rather then horizontical). it was great.
here is the link to it.
http://impactednurse.com/?p=27
also i think that i have alot of problem with my time managemnet at the moment, dont seem to go home on time. any tips from anyone? i think it is a real skill. and it is somthing we dont learn at uni. i need some tips. please......??
thanks again boyzmum for your great reasuring replay. i am a bit happier now
Hi. I qualified a year ago in the UK. The training was excellent, split half and half between classroom and hospital. Nevertheless is was one heck of a shock when I started work as a nurse. Had (and still have) great support in the ward and I love the job, but feel very inadequate. So many things you don't know but don't know if they are things that can be taught or must be experienced. The learning curve is steep but many of the students I have talked to feel the worst part is the first 6 months or so post qualification when you are finding your feet and learning just what a staff nurse is expected to do. Don't know if there is such a thing as the post qualification blues or even if other fairly new staff nurses feel the same way.
I graduated with my LPN 13 years ago and was SHOCKED at the difference between "school/book world" and the "real world"......today, I see the same thing happening with brand new RN's!!! They graduate with A's, honor society, etc and come to our little 9-bed facility thinking that a small-town hospital will be "quaint" and "slow"....a good pace to "break into"....NO, we do not have a 10 bed ICU, but we get the patients in our ER that must be stabilized and shipped out!! Have had 3 RN's recently work for us who had 12-15 years apiece of ICU/CCU experience who all LOST IT when they got their first MVC rolling through the doors...while our basic emt's were bagging and doing compressions! Here in Ennis, we can have 6 patients on the floor, have to man the ER and all this with one RN and one LPN....NO CNA's....NO RESPIRATORY THERAPY...NO 'CODE TEAM'!!! We 2 nurses ARE the 'code team'/IV team/Respiratory therapy/housekeeping/kitchen crew, etc!!! But, I would not trade again for a big hospital where you are on Med/surg OR ICU OR NICU OR ED!! Unfortunately, many of the new nurses simply are NOT prepared for working in small facilities where YOU are IT!!!
I'm a newly qualified staff nurse working in a hospital setting in northern ireland for the past three weeks. I can totally relate to the stress factor related to nursing. On my first day I was handed a bunch of keys 
and left to get on with it. So much for mentoring - non existent!!!!!
and left to get on with it. So much for mentoring - non existent!!!!!
My computer has been on the down side lately, so I am just now getting to read some of the topics. This one really hits me hard. As alot of you know my story and most of you are new you do not know it. Just to make it short. I am a seasoned RN. Been working hospital for the past 24 years. Worked Post partum, Nursery, Home Health Care, Cardiac floor, some surgery, you name it. My main area was ER as Emergency Cardiac Nurse for the past several years. We did 12 hour shifts and mine, by choice over the years was Friday, Sat, Sun. and yes you do become invisible to your family. Mine worked through the week and I worked weekends. We were a level 2 trauma hospital. Short staff, bad management or you might say indifferent management. You give everything you have and they wanted more. The stress of the job caused a bout with the flu to progress into hypertensive heart disease, because I could never slow down long enough to get well. I am doing much better from that now but it has taken over a year with medication coming out my ears. Then this May I fractured my right heel which lead to a damaged tendon which has had me in a brace up to my knee since May. So there went my 12 hour shifts and my usefulness to the hospital. As soon as my short term disability was finished I had to transfer to what we call a staffing service where we can work as we want. Which I have not been able to since May. I lost my benefits, my insurance and my position in ER. So much for the number of years you give to them. A good thing happened, I was offered a School Nursing job at the school My Granddaughter attends. I have been school nurse at 2 area schools since September. That my sound boring, but I really stay busy, but I do miss the ER action sometimes. I do not resent the job I am doing, I am very thankful for it. That is the one good thing about our profession, we can go many places.
My main thing here is that in our state the Governor is wanting to cut out the teacher's retirement for the future teachers. You know they can retire at age 50 with a gosh awfully good retirement. After they retire from here some of them just drive a few miles to another state and work 10 years and retire from there and 2 gosh awfully good retirements. Boy you should hear these teachers complain. I want to stand up and say, Look at me please. I have given my good years of life to a profession that saves life and helps people. On many occasions I have helped bring a patient back after cardiac arrest and on too many occ. have gottent to a MI in time to save that person's live. I have ruined my health and now my feet and legs doing a job where we do not even have a retirement plan in place unless we put the money in ourselves. When we retire or die, whichever comes first, we can barely walk and we have to be at least 65, I have to be 66 to even think about our SSI. To me just to think about retirement at 50 is a dream and 66 sounds like a very long way off at this point. These teachers, I know are wonderful in what they do, but they get annual wage increases and they get respect. To me I would take the respect and be happy with it on most days. Most of them walk around in their nice shoes (heel's mostly) and nice clothes, and you don't see to many of them limping around from feet that hurt so bad they can hardly stand it. They are saluted in our papers and on the news. How many times has nurses been praised for the job they do. We get our attention, Heaven forbit it happening, when we make a mistake or when some patient did not like the way we said hello to them. AND IT IS TRUE MOST OF US ARE ON ANTIANXIETY MEDICATION. IF NOT AT FIRST SOONER OR LATER. You don't hold people's lifes in your hands without suffering some anxiety, and if you do you need to get out of the business, because if it was me on that table I would want the nurse over me to be anxious over me, but to also have their wits about them and have great knowledge in what they do.
Ok, that is a summary of what most nurses has to look forward to in their career. You young guys in your 20's coming into the field have my greatest respect. Hang in there guys and make changes in our honored field and dedicate it to us seasoned nurses that have fought for years without success. We appear to be going backward and it is up to you guys to bring it back around. Don't settle, fight for your rights. BE PROUD and do your jobs well.
I SALUTE ALL OF US
My main thing here is that in our state the Governor is wanting to cut out the teacher's retirement for the future teachers. You know they can retire at age 50 with a gosh awfully good retirement. After they retire from here some of them just drive a few miles to another state and work 10 years and retire from there and 2 gosh awfully good retirements. Boy you should hear these teachers complain. I want to stand up and say, Look at me please. I have given my good years of life to a profession that saves life and helps people. On many occasions I have helped bring a patient back after cardiac arrest and on too many occ. have gottent to a MI in time to save that person's live. I have ruined my health and now my feet and legs doing a job where we do not even have a retirement plan in place unless we put the money in ourselves. When we retire or die, whichever comes first, we can barely walk and we have to be at least 65, I have to be 66 to even think about our SSI. To me just to think about retirement at 50 is a dream and 66 sounds like a very long way off at this point. These teachers, I know are wonderful in what they do, but they get annual wage increases and they get respect. To me I would take the respect and be happy with it on most days. Most of them walk around in their nice shoes (heel's mostly) and nice clothes, and you don't see to many of them limping around from feet that hurt so bad they can hardly stand it. They are saluted in our papers and on the news. How many times has nurses been praised for the job they do. We get our attention, Heaven forbit it happening, when we make a mistake or when some patient did not like the way we said hello to them. AND IT IS TRUE MOST OF US ARE ON ANTIANXIETY MEDICATION. IF NOT AT FIRST SOONER OR LATER. You don't hold people's lifes in your hands without suffering some anxiety, and if you do you need to get out of the business, because if it was me on that table I would want the nurse over me to be anxious over me, but to also have their wits about them and have great knowledge in what they do.
Ok, that is a summary of what most nurses has to look forward to in their career. You young guys in your 20's coming into the field have my greatest respect. Hang in there guys and make changes in our honored field and dedicate it to us seasoned nurses that have fought for years without success. We appear to be going backward and it is up to you guys to bring it back around. Don't settle, fight for your rights. BE PROUD and do your jobs well.
I SALUTE ALL OF US
This is a "lo-fi" version of our main content. To view the full version with more information, formatting and images, please click here.