I’m grinding up a steep hill on my bike. Quads are burning, breathing is ragged, the sun baked pavement stretches up ahead of me, taunting me in an inexorable gradient as sweat drips off my nose.
I’m focused, single minded in my intent. Nothing else clouds my mind except the turn of the pedals. The thoughts that woke me too early on this weekend morning forgotten, washed away by the wind on my face, burned away by the pain in my legs as I start another hill. It’s meditation on two wheels. It’s just what I needed.
It was a year ago 2/27 that I worked my last shift at the bedside. I was burned out, didn’t care anymore and looking for a change but couldn’t get motivated to make one. Taking a voluntary lay off was one of the best decisions on my career.
A year ago I dreaded going to work, dreaded dealing with the unstable mess I felt my unit had become and sick of dealing with the overwhelmingness of not caring. I cared about my patients but didn’t “care” about them. Maybe I allowed myself to get too close, didn’t keep and extend enough professional distance to not feel burdened by their issues. Whatever it was, I was not healthy, mentally or physically.
In the last 6 months I worked in Portland I began developing serious anxiety issues. I had never experienced an anxiety attack, but when the first one hit and I sat there vibrating like a guitar string, hyperventilating, freaking out over going back to work I knew something was not right. I was crass, callous, more cynical than normal. Short and rude with co-workers and unable to maintain the Zen-like ease that I had previously, I needed something different.
Different I got. Moving from a teaching facility to a small community hospital. Changing from bedside nursing to compliance and charge capture nursing (clipboard nursing…). Moving from a city to a small rural community. Going from 9 months of gray skies to abundant blue skies and sun. It’s like getting my life back. I’ve lost weight, learned to sleep normally again and rekindled that spark with my wife. Life, for the most part, is good. It took 5 years of death by a thousand cuts to nearly destroy me, luckily it only took a year to heal me.
And now I sit on my porch, blue skies over my shoulder, feeling the sun on my back and know it’s been worth it.
My wife and I were hanging out own the couch, chatting about a variety of topics from a local townhall on Agenda 21, gun control and what color of laminate flooring would look nice in our entry hallway and we looked over to see our two cats lazily lounging in each’s favorite spot bathing. They were so content, lulled into peaceful complacency by our dreams, our conversation and our simple quiet life. She said, “look at them, contented and happy” with a sad smile.
That’s when it hit me, like a sucker punch right in the gut: we had said that about our daughter. When they (my wife and daughter) were in the hospital we had a nightly ritual. The floor that my wife was on listed visiting hours at 9pm which meant I had to leave but since our daughter was in the NICU they would allow us stay visit as we wanted. So we would go and sit in her little room say hi to our little fighter and talk about our dreams, hopes and plans, just like we had while she was in the womb. Her nurses would always comment that before we got there things would be a little out of whack, a little agitated, working against the vent a bit, but as soon as we got there she’d calm down, eased into peace by our presence. They would then step out to give our little family time to be just that. Even with lines and tubes coming out of her little body she was peaceful when we were there. It is some of my best memories of her.
I realized my eyes had welled up and I saw tears in my wife’s eyes too. Even though it’s been over 6 years since she was born and we experienced something I wouldn’t wish on anyone and even when I think that I’ve healed from it, something comes along to remind me (us). If she was alive today I can’t begin to imagine how different our life would be. Luckily we still have our memories and even though they hurt sometimes, it’s nice to have them.
According to a recent survey, burned out nurses are more likely to spread infections. Here’s all the gory details: Burned-out Nurses linked to more infections in patients.
Having been a burned out nurse, I can see where this might happen. You’re tired, you’re pushed daily to give care to sicker and sicker patients and there’s more of them. Those of us who have tread that road know that it is not an intentional thing. These are small mistakes made through inattention, missed attention, attention focused on too many other things, complications of being pulled 7 ways at once that being a bedside nurse in inherent to.
But according to many comments left on the article, nurses are lazy and sit around all the time, it is all a conspiracy by the Man to keep the proletariat down, that being abused is part of the job, that we should just get over it and do our job correctly or get out of the profession. Very few voices of reason rang out, but this is the Internet and trolls abound. No one really gets it.
There is little to discuss why burnout happens or what our employers can do to help with burn out except for a short superficial look at staffing ratios. Unfortunately, staffing ratios are not a panacea, they are a means to an end, but unless coupled to acuity it is meaningless. Too often the cause is that there is too fluid of a patient population with huge swings in census, that hospital profits and administrator salaries are put ahead of nursing staffing, that reimbursement for many stays is a joke and that our patients are sicker than before.
There is hope though as the article mentions that when burnout symptoms ease, rates of infection go down. This highlights the obvious: happy nurses are nurses who can deliver the best care. Simple really. Too bad the things that would make many happy are the things that hospitals themselves would never realize. Instead they will continue to bury nurses under a blizzard of pointless paperwork, poor staffing, sicker patients, poorer compensation and even poorer support from those above in the hierarchy. We need though to learn as nurses how to keep us from transforming into Typhoid Mary even though we might be burned out and understanding of what can happen is the first step.
Locals ask me, “Why did you move heeere?” with a questioning sneer. It’s simple really: small town living, even with its different political/religious views, over-abundance of Bud Light, lack of “things to do”, is more palatable at this point in my life than ever before.
I love my little trailer. Sure, it’s a mess, but it’s our mess to change, clean up and fix up.
I love that I can drive to work in 10 minutes or less. I actually love that my in-laws are 20 minutes away, more because it makes my wife very happy to be close to her mom.
Most of all I love that it is quiet. Before I moved we heard gunshots daily, sirens all the time, noisy neighbors, bratty neighborhood kids screaming at all hours, general noise. I’m sitting on my porch and all I really hear is the wind in the trees and the occasional traffic on the highway.
Did I mention trails? Yeah, that too, literally right around the corner.
Some nice double-track in the pines.
Where the pavement ends.
Yeah, I’m a happy camper right now. Hopefully in 6 months I’ll still be signing this tune!
Truly, I’m not dead. I just feel dead.
In the week I moved I climbed thousands of stairs. Never, ever, living in a three story building again.
It took 2 days, well, actually 3 if you count the two hour jaunt the first day, to travel 1500 miles. The wife and I, along with our two cats in the front of a 24 foot Budget truck filled to the brim towing a vehicle.
Now comes the fun adventure of homeownership with all the little things. And finding a job. Yeah, still need work, but things are looking up.
Things are a’changing…and I couldn’t be happier!
The thing about moving is finding all the stuff you know you once had but had seemingly lost at some point. Case in point, found a box of old NES cartridges buried in a box deep in the basement. Next to them was a box full of old nursing school books… why I kept them I have no idea, but there they were in their spine-busting weight.
On top of those things I’ve been rewinding my personal mixtape thru Spotify, revisiting songs from years ago, finding new ones and having a good time. One tangent led me to an old favorite, Less Than Jake, I can remember spending hours with them as the soundtrack of my life back in the late 90’s, reading some of the books I found in another box, like The Master and Margarita and a collection of Lord Byron’s writings (I was a humanities major the first time through). Heady stuff.
Thanks to YouTube I can pseudo-relive seeing them live. The venue is very similar to where I saw them twice. Small, dark, dingy, hot and sweaty. They put on a crazy, zany goofball show, and I had a blast. Seeing them again makes me smile.
And, as always, those that complain get their way, and those that are strong take the patients. And those who smile and chat up the manager the most get the kudos, all the recognition and the praise. Then the administration wonders why staff satisfaction is down.
This is from a comment an ex-coworker posted which I had to share because it’s true. Toxic workplace much?
Being unemployed has brought some true clarity to my career and it’s been good. I realize that I was (still am) pretty burned out and am taking steps to remedy that. Breathe. Meditate. Reflect. Exercise. Sleep. And while I’m stressed out about moving, finding a new job and starting over, I feel like I can go back to being the nurse I want to be (again). It will work out.
It’s odd, I figured this unemployment thing would be like a vacation. Sit back, relax, catch up on things left unread, do some housework while slowly getting things for the imminent move together. I figured I would not miss working, prepping for work or the actual time spent going to work.
Yeah. Wrong on all counts.
Admittedly I’ve done a fair bit of relaxing. There have been many days of sitting around in sweats like some somewhat thinner suburban version of Jabba the Hut, dropping whatever snacks were within reach into my maw, ordering minions to do things (at least in my head). I’ve spent some quality time on Twitter, on some blogs, scoping out new places to ride when we move, but have done little of anything constructive. The place looks pretty much exactly like it did the week I stopped working. Packing? Psshh. Attacking the list of things I need to accomplish for the week? Did (the easy) 50%.
Never thought I would say it, but the hardest thing is not going to work. I see the #nocshift tag come up on Twitter for all those headed to slay the dragon of work and while I may be there in spirit, I’m really just an impostor now. I wish them luck and go back to doing nothing of consequence. But it’s the odd things that seem to mean the most to me. Not buying food specifically for work. Not staying up ’til all hours to readjust my internal clock to stay up for the next three nights. Not having the in-person interaction with my friends as we strive towards a common goal. It has made me slightly off-balance and I don’t like it. Coming from a long line of Scandinavian hard working folk, the need to work is etched indelibly into my DNA. Go too long without and I become insufferable to be around, pacing like a wild animal trapped in an enclosure but unable to do anything.
Worst though it has allowed my fear of not getting work even more real. It has allowed that nagging voice, the one that I used to continually tell to “shut the fuck up!” a little more volume. That little voice has been very, very talkative of late. Doubt, the killer of initiative, has been working overtime.
All this after only a week. I’m going to be a psychic wreck by the time I get to Arizona. And I will have probably driven my wife insane.
At least though, things are slowly coming together. It appears we have a place to call home lined up. There seems to be some jobs in the area that I could pursue. I just have to realize that things will take some time. This isn’t going to happen overnight, no matter how hard I want it to. The last time I was unemployed was so painful, more for factors beyond not having a job/income, that issues I thought I had dealt with long ago are bleeding into the current discussion which makes this more stressful. I have to remember that this is not like last time. I have experience. I have money coming in. I’m not running from death, disappointment and despair. Instead I’m running to something new, exciting and different. And you’e all along for the ride!
We are in the midst of the transition that prompted me to volunteer to quit my job and it sucks. Each day makes me realize what a good decision I made, but makes me worried for those left behind.
One of the biggest issues is that we’re combining two different units, one a typical med-surg/renal unit, the other a progressive care unit. Two very different staffs with different skill sets. The tele nurses are all ACLS and stroke certified, the others not. The tele unit started and built an observation unit and got used to and accepted the turn and burn mentality where you admit and discharge like there’s no tomorrow. The folks coming in rarely admitted in the levels we did and came from a more laid-back mentality. SO yes, it’s a huge transition, especially for the new folks on our staff, huge changes in both practice and mentality. Add to that increased patient ratios and people are already starting to question the status quo.
The worst though is for the nurses perceived as “strong”. You know the ones that can take anything you throw at them, rarely bitch and just take their lumps, the ones with the advanced skills. They get the more difficult patients, the sicker patients, and more of them.
The other night was a perfect example of that for me. I started with 4, a decent mix of patients. (yes, I know, our ratios are low compared to some, but we have minimal support staff, it’s all about perspective too). Charge nurse comes to me with a proposition: drop one of my patients to take stroke admit. She figured it was easier for me to do this instead of giving the only other stroke nurse a 5th when she had never taken 5 patients before. This is a full on stroke, large MCA nastiness and there are a lot of things to do since we’re in the acute window. What choice do I have? I’m not gong to be a dick and say “no, let ‘em suffer” am I? Not really. So I admit the stroke and considering now the CT looks, I lucked out. Then she comes back asking me to take a chest pain admit since the only other nurse just “can’t”. Whatever. They ask because they know I will only say no if I truly can’t. They ask because “you’re strong and can handle it, the others can’t.”
The last night I worked it happened again, I get the admit while the others don’t because “they haven’t done it.” And it’s not like I don’t want to work, I take my lumps but I believe it should be fair, at leadst to an extent. Give an equitable load, don’t dump on the strong nurses because you can. What comes out of that? Burnout. Demotivation. Animosity.
A good friend of mine who is staying mentioned all of this to me the week before we changed over. He’s a guy who never complains, I mean NEVER. And he was upset, worried and generally disaffected. Did I mention he is a guy who always has a smile on his face, even when glove deep in poop? To see him so upset truly shows me the folly of the madness being inflicted on us. Here’s a nurse who smiles through everything, who gets every single LOL to love him, who’s clinical skills have grown immensely since hire to be a very competent, caring and effective nurse who will be put through the wringer because he’s “strong” and they run the risk of losing such an employee. But in the end “they” don’t care, it all comes down to money.
That is why I feel bad for my former colleagues. It’s going to get worse before it gets any better, if it ever does. The unit we spent years building was destroyed in one fell swoop and is reverting back to a mire of poor management, burned out nurses, massive regular turnover of nurse, disaffected staff and a manager who is crushed by those farther up the food chain. Sadly it all lands on the patients and while there will be nurses who strive to keep the level of care the same, you can only fight the tide for so long. Hopefully the worst of my prognostications doesn’t cone true. One can only hope.~disclaimer: I know there are places with far worse ratios and worse conditions, we’ve been incredibly lucky for a long time. Leave it at that.