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September 29, 2002
Sunday, September 29, 2002
It’s been an interesting weekend, to say the least. I have gone through some very personal “self discovery” moments this weekend and while it hasn’t necessarily been an easy journey, it certainly has been enlightening.
I have made some very serious decisions where my career is concerned. No, I am not quitting my job altogether… that is a fantasy that will probably go unfulfilled for a long time, if ever. But, there are some serious changes coming. As the bible says, there is a time and a season for everything, and this is definitely my “time and season” for big change.
I currently work on a cardiac telemetry unit in my hospital. I have decided that it is way beyond time to move on. I had a horrible night on Friday night. It was so bad and the next morning, as I sat, charting nearly 45 minutes after I had gone home, I had a serious revelation. It is amazing to me how personal revelation is given to me… it is never like it is on television… there are no light bulbs popping in my head, no fireworks, nothing like that… it usually happens in a quiet moment when all of a sudden, it’s as if someone comes along and sweeps the cobwebs out of my brain and all of a sudden, the picture becomes so much clearer. The picture, it seems has always been there, I just haven’t been able to see it very well. The cobwebs… what are they? Well, they are a number of things… personal blindness, judgments, and all too often, worry about what others will think of me. Once I can remove those blinders, it’s amazing what I open myself up to.
When I say I had a horrible night on Friday, that is really an understatement of gigantic proportions. I came home and promptly got into a very ugly fight with my husband… something that is a rare occurrence for us. There was actual name-calling involved… something we have ALWAYS refrained from, because it’s childish, it solves nothing, and it’s ugly. Once we left each other alone, reunited, talked it over and hashed it out, we realized that the fight had nothing to do with us… it was all about me and my job and the realizations I had made.
He took Ethan and left for an hour or so to give me some space. I sat down and wrote a letter to my two nurse managers. It is a letter that I have no intention of giving them right now, but I had to write it while all of the feelings were in my head. Hear are some excerpts from that very long, 5-page letter. “B” and “D” are my managers. “S” is the name of the hospital I work at. Please know that this IS a condensed and abridged version. I have excluded some information about the job as well as a paragraph singing the praises of both B & D (they are wonderful people and isn’t their fault that the politics are the way they are). The paragraph of me singing their praises was personal and so I chose to leave it out.
For many of you, this letter will mean nothing. I use a lot of nursing jargon and abbreviations. But, this is my diary and I wanted to include it here. I also hope that maybe some other nurse out there will get something out of it. I would LOVE to hear from any nurses… please, share your thoughts with me.
Dear B & D:
I am writing this letter today because I need to get my feelings down on paper while the emotions are still fresh in my mind. Why am I writing this? Well, it’s not because I think you can fix any of these problems. I am hoping that if there is a recruitment and retention committee somewhere in the S hierarchy, that you will share this letter with them. I am sure it won’t be the first such letter that either you or they will have received, but I guess I feel like the more voices they hear, maybe it’ll make a difference to someone, someday.
I am tired. I am burned out. I can’t do this anymore. Last night was probably one of the worst shifts I’ve worked in three years. No, my decision to move on to other realms of nursing was certainly not based on one shift… this shift was the straw that broke the camel’s back, so to speak. As I sat at a computer, charting at nearly 0800 this morning, I had a shining revelation. It was as if my mind was truly opened for the first time and I realized that I no longer belong here. It didn’t hurt. I didn’t feel bad. I was simply validated.
I had six patients last night… the floor was so busy that I didn’t even get a report on my first patient until 19:30. As I got report from the two day shift nurses, my list of “Things that need to get done immediately” grew by the minute. My fresh pacemaker patient was rolling back to the floor from the O.R., there was blood that needed to be drawn from a line so that TPN could be initiated in an hour, there was a CABG patient who was acutely short of breath (and just got worse all night long), there was a confused and combative patient who needed Ativan and Morphine, there were missed orders (IV lasix that should have been given, blood pressure meds that were never given, etc.), and an NAC who kept coming back to me with “yet another” elevated blood pressure that needed immediate attention (I’m talking 220/90 and 200/86 on two separate patients).
Aside from all that, I had two separate families that single-handedly made my night horrendous. I am tired of dealing with unruly, rude, and condescending families. I feel as though I come to work and I’m required to take their abuse time and time again. Heaven forbid we should say anything to tick off a family member… after all, we’re “S” and we provide the best care and the customer is never wrong. I’m so tired of hearing about lists of patients who will only have “certain nurses” caring for them because they don’t like others… or how their every detailed expectation is not being met with 100% compliance. I’m tired of being yelled at for things nurses before me have or have not done. I’m tired of being treated like a 3-year-old by families. I’m sick to death of feeling intimidated every time I walk into those rooms. I honestly don’t believe that I am compensated enough to take that kind of treatment.
It frustrates me to no end that the UPS and Federal Express drivers that live down the street from me make more money than I do for delivering packages. I am not downplaying the importance of their jobs, but I do save lives for a living… obviously no one sees that for what it is worth… or at least believes we should be compensated as such. I have been told, “But they do back breaking work.” HA! And I don’t? I sacrifice my back on a daily basis.
I am tired of having to float to units where I have had ZERO orientation or training. I am sick of going to units where my patient load is larger, I have less help, the paperwork is unfamiliar, and I am not trained in that particular specialty. It is terribly unsafe. Why does S do this? S obviously has money… so if the nurse screws up, tell me… does S take responsibility for that or does the nurse get reprimanded and possibly lose his/her license? I once floated to the renal unit where I was given 7 patients, all of whom had had surgeries I was totally unfamiliar with… bladder resections, prostatectomies and such… It took me a solid hour just to figure out what medications I had to give and when… the medication administration records were horrendously hard to read and very, very complicated (instead of one med sheet, there were tons… a Coumadin/INR sheet, a pain sheet, a heparin sheet, an insulin sheet, a PCA sheet, a PRN sheet, a one-time sheet, a drip sheet, a routine med sheet)… how complicated is that? When you are not familiar with this, it takes forever to figure out what you have to give and when. I had patients with bloody Foley catheters and I had no clue if it was expected, abnormal, if it should have been reported, etc. The flowsheets are completely different. None of the units are standardized in ANY fashion… the clean utility room is in one location on one unit and in a completely different location on every other unit… meds are kept in different places wherever you go… codes to doors are different… so many differences… yet we are supposed to float to these places, take on these assignments, function well and see to it that these patients get what they need… and don’t forget, get it all charted. Heck, report is different on every floor… some floors tape, some do a group/charge report, some use crazy little cards… ZERO STANDARDIZATION. It’s very unsafe. Are we compensated for this? Of course not. If you join the float pool, where you EXPECT to float on a daily basis, you an extra $5/hr. But when you are yanked to a different floor, totally unexpected, where you are not used to the routine, the staff, or the system, you get nothing.
In a 12-hour shift last night, I used the bathroom once and never got a break… not even 15 minutes off the unit. Yes, the charge nurse helped me where she could, but she has her own responsibilities and I wasn’t the only nurse sinking. This is not fun anymore. I no longer look forward to coming to work… I dread it like the plague. I admit that I have had difficulty keeping a sick leave balance since the birth of my child. After nights like last night, I never want to come back. The acuity is getting higher… but that is all that is changing… the staffing isn’t changing to compensate for the increase in acuity… and my paycheck certainly doesn’t reflect an increase in my workload. I should not have a sense of fear or dread when I walk into work each night. I shouldn’t think, “God help me… here we go again… please Lord, just help me get through this shift.” Life is too short for that.
I can see why nurses are leaving this profession in droves. I can see why the burnout rate is so high. Why become a nurse these days? What is so attractive about it? Why become a nurse when you can become anything else you want… and get hired by a company who will offer you attractive retirement benefits, stock options, more vacation, paid maternity leave, bonuses, and other perks? I admit, I like my schedule… it allows me to make a fair (not great) amount of money working a minimal number of days. It allows me to be home with my baby. However, right now, that is really the only thing that keeps me here. Otherwise, I dream of getting out. I dream of doing something different, but I have felt stuck here. Not so anymore.
It is time for me to move on. I spent a lot of time, emotions, money, blood, sweat and tears to become a nurse, so I am not giving up on the profession completely. I am, however ready for a happier specialty. I am going to pursue the field of perinatal nursing. I have wanted to explore this area of nursing for a long time and I think now is the time to act on that desire. I often talk to perinatal nurses and they speak with such fondness about their jobs. They are given the tools and the resources to do their jobs well. Is it a perfect realm of nursing? Certainly not. I am not expecting perfection in the least… I know that it holds its own share of stressors, difficulties, and challenges… but I am ready for some new and different challenges… in a field that generally has a much happier focus.
It took me a long time to come to this decision. Part of me felt like I was being a coward if I didn’t stick out telemetry and eventually move on to the ICU (like many good tele nurses do). Part of me felt like moving to perinatal nursing was somehow “stepping down”. Part of me felt like I would be looked at as a failure as a nurse or that I just “couldn’t hack it.” Even my husband proudly tells his friends and coworkers, “My wife is an RN at S” and he loves the response he gets from people… part of me even felt like I would be letting him down to work elsewhere. I now realize that none of that matters. I need to do what is best for me, my family, my sanity, and my life. I can no longer justify the 60-mile roundtrip commute I make to S, only to have to “psych myself up” just to walk through the door. It’s not worth it to me and it is most definitely affecting my marriage and my personal life. It is time for me to move on. There is a time and a season for everything… it’s my season for change.
I hope that nurses start getting treated better really soon. It’s a very thankless profession. Somehow, I doubt that will happen… and new nurses will continue to leave the profession in record numbers. Until nurses are valued for their knowledge, compassion, expertise, and professionalism, I see little hope for continued retention in this field. I know that I have talked to many, many of my fellow coworkers and the general feeling has been one of hurt… especially when S offered $5,000 bonuses to travelers… and gave their own staff members (the ones who choose to stick it out in the trenches every day) a calculator or a pen or a mug as a gift. Come on. I am worth more than that. I am going in search of a place where I will feel valued for my contribution to the field of nursing. It may take me a long time to find it, but I’ve got to keep searching… I owe it to myself and to my family.
***End of letter***
Okay… so that is my letter.
***********NURSES OUT THERE… PLEASE TALK TO ME!!!!!!!!!!!!!!*************
I’m not sure how many nurses will even read this entry, being that my diary and this site are so new. But, if you are out there and read this, please share your thoughts with me. How are you all handling the nursing shortage crisis? What are your challenges? What keeps you in this profession? How do you stave off burnout???
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