Of course, that anxiety faded as I actually figured out what I was doing. Slowly the insomnia and nightmares drifted into a good nights sleep and I actually enjoyed my job for many years.
But as things in life go, we have come full circle. Although this time around my tears are not related to anxiety or feeling over whelmed. My tears these days are a product of repression and boredom.
It was only 6 short years ago that I was a squirrely young nurse feeling overwhelmed by every new order that was written or by a any doctor that looked like he might talk to me. I distinctly remember talking with my favorite Trauma NP, Bob, about Patricia Benner's Novice to Expert Theory after about a year and a half of nursing. He pegged me as an "advanced beginner", which was incredibly accurate. I had so much to learn, even though at that point the nightmares had stopped and I was feeling fairly confident. But somehow unbeknownst to me, I have climbed through those levels of nursing and am now looking for a new challenge. For the record, I am not saying that I have mastered nursing. It is indeed an art and I will always have more to learn, but the big picture concepts, the gut intuition, and the flexibility I have down.
So here I am, six years into my career and I'm bored out of my mind. I have thought about changing specialties. ICU perhaps, PACU, maybe even L&D to really change things up. But the more I think about those options I realize that I'm not really excited about them. The chance of having to go back to night shift for God-knows-how-long is not appealing, the ICU where I work does not have a good reputation, and the fact-of-the-matter is that switching specialties feels like a band-aide and won't actually fix the issue and in the end it is essentially the same job. I would anticipate after another couple of years I would feel bored again.
One of my big gripes with nursing is that there is no ladder to climb. I am doing the same job I did six years ago. I mean, I am doing it better and more confidently now, but over all it is essentially the same job. And when I say JOB I mean JOB. Nursing to me is not much of a CAREER. There is very little room for professional growth - or at least professional growth that any one cares about. I will say, that that my current job gives me an extra $1 per hour because I am certified, which I greatly appreciate, but when it comes down to it I am still doing the same job. My certification is in Progressive Care (ie Step Down Unit or an intermediate ICU) but even with that certification and experience in a Step Down Unit I am still not allowed to work in my hospitals IMCU. I have talked to management and they are giving the me run-around saying "I'm on the list" to orient. But I have been on said list for a year now with no movement. Why? Money. They'd have to pay me more as a "critical care float nurse" and they don't want to.
Which brings me to my next gripe about nursing: money. Health care is a business, that is not a secret. But working the nurses into the ground, constantly asking for more out of them, with no further compensation does not give a lot of inspiration. The big push right now is regarding HCAHPS scores because the better a hospital does the bigger their reimbursement. But is the hospital enticing us with a bonus or pay raise? Nope. We get a pizza party if we do well. Wow, how generous - a buck-fifty a person and they feel guilt free. Well screw you because I can't even eat pizza. On a similar note, I only got the 2% market increase raise this year even though "I did really well and got great comments from my co-workers" by the end of my review my manager said "wow, you really did do well, I probably should have marked you higher". Wait, really? I have to wait a whole year before I'm even eligible to get a raise again even though I worked really hard, got great feedback from my peers and charge nurses, and met all of your criteria this year? That moment marked the beginning of the end for me. I realized that I can be a half-assed nurse and get paid exactly the same as if I work my tail off. No one really cares, except the patients of course. Though, sadly for my wallet, I care enough about the patients to continue working my ass off every day which is only accelerating my burn-out.
Moving on to my most recent qualm with nursing, and perhaps the "straw that is breaking the camels back", per say, is the micromanaging leading to repression. There is a check list and protocol for everything. I understand this is for patient safety and continuity, which I completely support, but there becomes a point when it has gone too far. We are, after all, adults and "professionals" and were supposed to have learned most of this stuff in school. It feels fairly belittling to have someone watching over my back making sure every piece of the nursing process is completed to their satisfaction and then getting dinged on stupid shit - ie not utilizing their brand new fancy magnets for the communication white board to discern the activity level of the patient. Simply writing "CALL FOR HELP TO GET OUT OF BED" in bold black ink is not sufficient. No, we must use the yellow magnet that says in tiny print (for 80 year old eyes) "Staff assistance needed for all out of bed activities." Now, I think it's fantastic that the hospital decided to spend unnecessary money on color coded magnets instead of giving their nurses adequate raises, but I'm not sure it is any more effective then good-ol' education and legible handwriting.... but what do I know, I'm just a nurse.
Their most recent soap box (and subsequently my most recent soap box) is the issue of hiding our beverages in a drawer. This is "for our protection" so we don't contract certain blood borne illnesses such as HIV and Hepatitis B & C. It is apparently a CMS regulation which is why they care so much. But I have asked both my manager and the freaking Director of Med-Surg Nursing about this rule only to be pushed aside. Nothing they say makes any sense. In my discussion with Leslie, the kind of cool but mostly terrifying director of Med-Surg Nursing, she got legitimately pissed off when I questioned her. Our conversation started in a fairly demeaning way: "What am I looking at that I shouldn't be looking at?" she questioned. When I told my elementary-school-teaching-fiance about this he said "ha! That's what I say to my first graders!" Well anyway, I was as calm and respectful as I could be reassuring her that I wasn't trying to be defiant but am simply a logical person who needs to know why I am being asked to do something. She continued to give me some bull-shit explanation about how if someone doesn't wash their hands and then they touch my cup then I'm at risk (first of all, why aren't they washing their hands, secondly why are they touching my cup in the first place and third of all, how is their hand-goo getting INSIDE my covered beverage). But I didn't ask questions because her forehead vein was protruding. The conversation ended with "put your drink in the drawer right now or else" and "you're going to do it because it's the rule." Great, thanks. What ever happened to clinical significance and evidence based practice? Show me the clinical studies with statistically significant data that show nurses getting HIV from drinking water at their desk and maybe I'll be compliant. But simply telling me "its for my protection" and to do it because its the rule is militaristic bull-shit and I can't stand it. I was raised both as a nurse and as a human to ask questions and critically THINK about what I'm being told. And yet, when I do I get squashed.
When it comes down to it I'm tired of being treated like a child and I'm ready for a grown up job.
These are the things that are sending me into the supply closet to cry these days and I'm not quite sure what to do about it. In the past when I've reached the burn out stage I knew it was time to move again. The change in scenery, management, and unit were usually enough stimulation to make the job exciting again. But now that I'm in a committed relationship and hoping to start a family soon that is not as much of a feasible option. So whats next? Back to school seems like the only option with a pay-raise, but thats a huge commitment and enough pros and cons to fill another entire blog.
Perhaps that is the perfect end to my nursing career coming full circle - winding up back in school.
