A Dark Place
I haven’t been around lately (maybe one or two of my three readers noticed). I went to a dark place in the world of nursing: a long tunnel filled with fears, regrets, and frustration. I really didn’t think I would be able to come out the other side of this darkness, I still haven’t, but at least now I’m 68% positive I will.
Let me explain:It happened as quickly as someone flipping a switch. I went from being excited about my career, from engaging and learning, from dreaming of future career paths, to hating every moment of every day that I had to be a registered nurse.
Some would call my symptoms depression. I was nauseous all the time, I was exhausted and slept twelve hours a day, I struggled to leave my bed on my days off, and if I did, it was only to lay on the couch and watch television. I was miserable and cranky, moody and angry.I would start to cry at the thought of reading nursing blogs or forums.
In disgust, I ran from everything nursing related.To an extent, all these feelings are still there, they are simply improving. I have yet to truly regain my desire to be a nurse anymore, going so far as to look through job search sites, browse college program brochures, and contemplate running away to become a Buddhist priest.
These are the examples/things that are getting me down.
1. Learning the ICU is a tough gig. My knowledge base is general surgery, not trauma, neuro, or medical. Every day I’m given a patient that I’m absolutely clueless about. Drains I’ve never seen, equipment that is mysterious, treatments that are frustrating, and procedures that are completely bizarre. And of course, as an ICU nurse, you feel as though you should know everything about everything. What I wouldn’t give for a nice simple bowel resection patient. And, frankly, I have barely even begun to learn ICU nursing. Soon, I will be expected to take my ACLS and start being part of the code blue team, then I learn PA catheters, then CRRT, and on and on. There is never a moment where I get to feel comfortable. There’s never a day I walk in and see my patient and say, with confidence, “I know exactly how to deal with this.”
2. I’m tired of being tested. I’m tired of having other nurses breathing down my neck. I’m tired of being treated as though I came with zero experience and need to be helped with every little skill. Who knows, maybe I’m doing a horrible job, but nobody has said anything, and one would hope they would. I’m very good at knowing my limits–I’m almost too cautious–so trust me, I’ll let you know if I need help.
3. On two occasions, when my patient was in trouble, despite doing a great job at handling the situation and stabilizing my patient, I was told I was too calm. “If it were me, I would have been freaking out. I didn’t even know you needed help. If you needed help, why didn’t you ask?” First of all, I did ask–just not you. I had a doctor and another RN who was familiar with my patient helping out. Second, since when is staying calm in an emergency become a negative?
I can’t believe I was accused of being too calm by two separate coworkers on two separate occasions.Let me just say this: Just because I’m new to the ICU, it doesn’t mean I’m a new nurse. I’m used to dealing with very similar emergencies on the floor with less staff, no doctors, and less resources in the form of medications and monitoring equipment. Perhaps I’m not panicking because although things are going bad, it is in a very controlled environment.
Next time my patient’s MAP is 48, I will jump up and down, scream and shout, cry and have a nervous breakdown. THEN I’ll get the fluids and Levo. Makes so much more sense.
4. I’m not a bitch/asshole. Therefore I’m not a good nurse. I’m not bossy, argumentative, crude, crass, or rude, therefore, I’m simply not a good advocate for my patient. I’m willing to wait a minute or two for my doctor to finish with another patient before discussing my issues, rather than interrupting him rudely to come attend to my patient’s needs immediately (not an emergency by the way). I shouldn’t let doctors dismiss me like that, I was told. Ugh!
5. I don’t spend my entire day complaining about management, the new residents (I can’t believe how mean some of these nurses are to them!!!!), attending physicians, nurses on other floors, my patients, the colour of the curtains, or worst of all, I don’t say rude things about my patient, such as “what a waste of skin!” within hearing distance. Therefore I’m not hardened enough and jaded enough to be a good nurse. I’m too kind and sensitive.
6. Example: My patient had recently been extubated. He was sitting in a chair comfortably, laughing and talking with his family, his lungs sounded clear, he was breathing about twenty resps a minute, he was on 2L of oxygen, and his Sats were 99%. He was all ready for discharge. I did a blood gas. Apparently, I’m a bad nurse because I didn’t run to the doctor in a panic (yes, apparently as an ICU nurse, I’m supposed to be panicked all the time) because his C02 has risen from 44 to 50. Sure it’s high, but we treat the patient, not the numbers, right? It’s an important number, but I didn’t see the need to panic. I’m a bad nurse.
7. I’m tired of working twelve hours on weekends, holidays, and nights. When I started nursing school at age twenty-four, was single, and loved to go out all days of the week partying, working shift work seemed like fun. Fast forward to six years later, I’m in a relationship with a kid (my dog) and it just doesn’t fit my lifestyle anymore. I want a “grown-up” job where I work in an office downtown, get weekends off, get vacations (almost impossible right now with my seniority), get Christmas off, and most of all, I want to come home after work with energy to do stuff in the evening–rather than be so exhausted that even breathing is hard.
8. I’m truly tired of dealing with patients, and especially families, that are completely horrible, ignorant, rude, people. I want to spend my days surrounded by well-balanced individuals for a change.
These are the tangible ideas that I am able to write down. There are also many intangible feelings that I just can’t put into words. Honestly, the best way to say it is that I feel as thought there is a dark cloud over me and my career. I’m trying to snap out of it, and I’m slowly succeeding. But really, this is why it has been so tough to write–I simply didn’t want to think about nursing whatsoever.
Sorry for the depressing post, but I thought I’d explain a bit about my absence, and give a bit of an update. I regret that I won’t have numerous posts about the many interesting firsts over the past few months, but alas, I just couldn’t do it. Here’s hoping things improve!
Edit: Thanks everyone for your wonderful comments! I wish I had written this earlier. Just writing it all down made me feel better, but to do it in such a supportive public forum is that much better! Just to clarify though, I’m not a new grad. I worked on a surgical unit for two years prior to ICU 
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This post really broke my heart. I feel for you, man, I really do. I spent 8 years as an ICU nurse, and had all those feelings that you’re talking about, even as an experienced open heart recovery and trauma resus ICU nurse. It’s a brutal profession, and ultimately, I burned out after 8 years (which is a minor miracle, considering the burnout time frame is usually 18 months or so). I found other avenues to go down–OR for one, in a smaller hospital, in a friendly city.
I finally threw my hands up at hospital nursing, and these days I run a 120 bed skilled nursing facility, doing about 1/2 and 1/2 short-term rehab and long term care. I would have never dreamed i’d be a director of nursing, but here I am, and I love it. A window opened, if you know what I mean…
I wish I had an answer for you, but I just wanted to let you know that I’ve been there, and that there ARE other avenues. Do what keeps you sane, and happy. If you aren’t than what’s the point, you know?
So, so, so, so sorry. I am not a new nurse yet but my most recent ICU experience involves plenty of those feelings. I don’t know what to say, what kind words will help you get through this. I can only wish the best for YOU, whatever decision that may be. Perhaps a different ICU? I would hate to see the profession lose such a nurse so early on. Maybe this is what’s wrong with us…keep us posted and don’t be a stranger. There is a nice group of nurses/health professionals on Twitter if you are interested. You can find me under Brain Scramble and I will take it from there. Join us, we support each other when others don’t.
In so many many ways I feel your pain. Much of what you wrote feels like something that I could have written. Reading points 1, 2, 3, 4, 5, and 8 really felt like something that I could easily have written. Fortunately, I have not fallen into the dark tunnel of nursing despair, but I hope that it helps at least a little to know that there is another reasonably new nurse out there who feels your pain and can completely sympathize.
Sometimes in the ER when everything is happening at once and it feels like the world is crashing down, I find myself wanting to cry from not knowing how to proceed next. I have nothing but admiration for you in tackling the huge knowledge base needed to be an ICU nurse.
Good luck!
Hi Caroline and NurseExec, thanks for the kind words. Caroline…I’ll add you on Twitter!
Thanks to you too Braden! We must have written our comments at the same time. I didn’t purposely leave you out
Wow. This post brings it all back for me. I remember feeling that way during my ICU orientation. It was honestly the hardest thing I have ever done in my entire life.
Don’t be too hard on yourself. I think you sound like a great nurse - I can tell from your writing that you have compassion. This is sometimes missing in the ICU. The ICU is a place where you will find a lot of drama queens and know-it-alls. Don’t let those types get you down.
My suggestions…
Try to find someone at work that could act as an informal mentor to you.
Keep on blogging - even if it’s just a short post to say “Help!!! I’m drowning in ICU bullshit!” We are a very supportive community. Lean on us.
And if it gets to the point where none of that helps and you are still miserable, don’t be afraid to try a different kind of nursing.
Also- Someone told me I was “too calm” during orientation (a nurse educator, no less!) That is utter nonsense. The ICU needs people who are calm and collected.
I went through a period like this and I don’t even have my license yet!! I despised anything to do with nursing…yeah, everything you said. I drowned in unreasonableness and hatred of my job and school. I feel better lately, but it took probably 6 months. My original reasons for wanting to be a nurse are starting to bubble back up. Good luck.
Not really much I can say, other than I wish you well. And don’t worry about those other nasty nurses.
It always takes me several weeks to start really enjoying a new position - how long did it take you to start enjoying your old unit?
hi sean. i came to your blog via pixelrn and i wanted to let you know - it gets better! like the many who commented before me, we all go through this. when i first started in the ICU i often felt overwhelmed and unsupported. nurses attacked me because of my pleasant demeanor, mistaking politeness for an inability to be a patient advocate or worse, a good ICU nurse. i would go home and cry almost every night.
fastforward a few years and those same nurses are eating crow. the same co-workers who criticized me are coming to me for help and advice. i’m chair of the leadership committee, preceptor, charge nurse and hold a seat on our system wide nursing committee, the professional practice counsel. physicians have offered to provide tuition assistance to finish my MS to work with them!
my point is, don’t give into your feelings, and keep doing what you do - being a great nurse! soon naysayers will respect you for who you are. there is a light at the end of the tunnel! goodluck!
wow, I have to agree with the other poster..I could have written this very same entry 10 years ago. Why does it have to be like that? I swore to myself I would NEVER do that to one of my orients. When I arrived in the MICU I had been a nurse for over 4 yr. My med-surg floor had closed and was forced to take a new position in the system. As a floor nurse we had 11 patients a piece and one aide. One snide nurse told me “we are going to teach you what it is REALLY like to work here”
Are you kidding me? I worked like a dog on the floor! I cried more than I ever had in my life..on the way home and on the way in every night. Looking back it was such a waste of my time to let them do that to me, but when you are told you are not doing what THEY think you should, you can’t help it.
I hope it does get better for you and that you stick with it. You will be so proud of yourself in the end. You know the challenges will continue every day. For me 10 yrs later, I still learn something every shift and many days I question why the hell I do this.
There will ALWAYS be those families who question “umm…is there OXYGEN going into the vent?!?!” and making you bite your tongue.
Take it from this “too calm” nurse…you will be amazing and you will help so many people.
All the best!
Sean,
We nurses, ALL feel your pain. I thought I’d take your stresses one at a time. So this might be long.
1. Learning the ICU is tough for anyone nurse, let alone a new graduate. I can tell you it takes almost 2 yrs to get comfortable in your new ‘nurse skin’. And that’s staying in the same specialty. It’ll be 6mos on your own (off orientation) before the butterflies go away. Another 4-6months before that “I hope I don’t kill anyone” feeling will disappear.
2. You WILL never know everything. You WILL always be tested. Even years after being a nurse. But you should also be getting feedback, good and bad. Our orientation program requires our orientees to meet weekly to discuss the positives and negatives of your week
3. I think most nurses just expect a new grad to ‘freak out’ because that’s the norm, and they may not know how to deal with your calmness. Being calm is not a bad thing. not acting promptly to a situation IS! Keep up the good work.
4. Maintain your professionalism, but at the same time give respect as much as you demand your own. Most doctors need to ‘evaluate’ your skills and knowledge before they give the respect you so rightfully deserve. I agree, being the not nice person will get you nowhere fast
5. There is no such thing as caring too much. That’s the difference between being another nurse, and being a good nurse. Don’t ever stop caring. It makes your patient and YOU a lot happier
6. Treat the patient and you’ll never go wrong. It’s all a matter of tactic. Continue to update and communicate with the physicians, while acting appropriately. Do not let a nurse tell you their way is the only way to do things!!
7. Welcome to nursing. Maybe ICU nursing is not for you due to the schedule. The great and wonderful thing about the nursing world, is the vast amount of options and opportunities that are out there in regards to your wants and needs. (ergo.. no weekends, holiday, nights)
8. LOL.. this one slays me. Good luck with that endeavor. We take the good with the bad. The good keep you going, while the bad make you appreciate the good even more. Once again welcome to nursing.
I went straight to the ICU as a new grad. So I know it’s tough. It’s all about what you want out of nursing. I love the ICU for all it offers, we each have to make our own path.
I truly hope you don’t judge the nursing world simply by what your first experiences are. If it’s not for you, and your lifestyle Change the scenery.
Best of luck to you.
hi sean,
this post brought back memories for me. it would seem that there is this weird plane as a new grad where you are damned if you do and damned if you don’t. i hated it as a new grad 18 years ago and i hate it nowadays when i see new grand colleagues struggling or more experienced colleagues forcing them to jump through these hoops.
it sounds like you are doing right by your patients, making good calls and asking for help before you start drowing and i think that is a very good thing. we all should practice more like that i believe.
what got me through that tunnel and gets me through the real ass-sucking nights at work is the friendship and validation with trusted compadres who know too well what i am feeling whether they are face to face contacts, online contacts (blogs, email, facebook) and twittering, lots of twittering
hang in there. i hope to see very soon that you are coming into the light.
Hey Sean,
Good vent, that’s probably something I need to do as well. I’ve been an RN (ortho) for 1 year and ask myself everyday “is this all there is?” But I look at the other end of the spectrum, ICU, and say “that’s not what I want.” But with weekends, holidays, and nights off, it is not realistic to get more than just the blahs. Blah blah blah, everyday blah. Did I make the wrong decision by switching from my high-paying cushy office job to a low-paying body-bruising job?
Maybe the world will end in 2012, so look on the bright side
regards
Hang in there buddy! I’m sure things will start to look up soon
Thank God. I am so thankful for the honesty of your post. I especially connected with point 7, which was the main reason I chose not to pursue nursing, despite being accepted into a degree program. I bolted and chose social work instead, will be getting my MSW and my weekends off.
Ack! Social Work = My idea of a nightmare!
Thank God you’re around to do that job, and thank God to all the social workers out there that love there profession. The hospital would grind to a halt without you I think.
Hi Sean.
I’m sorry you’ve had such a rough time of it. The ICU is tough. Nights do suck. Holidays suck. Ungrateful b@stards whose lives you save typically suck…and that bit doesn’t get better because the fact is, a lot of humans suck.
(I’m not making this better, am I?)
I’ve been in the ICU for 9 months and some days I love it. However, I gave my notice last night because I’m going off to do acute dialysis. It was really hard to do that this morning, after one of the best shifts in months.
Like you, nights were not a problem at first. My ex-husband did nights, and then through my divorce and the Year After The Divorce, I worked 5 12’s a week because I wanted to live in a dark hole in the ground and not see sun. They year after, I wanted to go out partying and found lots of other fun night-shifters who enjoyed being out until 5 a.m. But now. I’m in a happy place with a man who lives in the daytime. And I’d like to spend time with him and not be exhausted.
I love the ICU. I love the sick as snot patients. I really do. But for every golden shift like last night, I get 10 stupid shifts. I have long since lost count of the number of times a patient or family member has thrown a punch at me.
Sounds like many of your colleagues are expletives, though. The best part of my ICU is most of the people I work beside. It can take a long time for them to trust you and your judgement. Best to just tell yourself that you keep pluggin on and they’ll get over it.
I wouldn’t do trauma ICU for all the coffee in Columbia, for the reasons you cite. I like medical ICU. Much messier and more complex clinically, usually less so emotionally.
I could say Hang In There. People always seem to crash and burn six months into the new job, whichever the new job is. It’s possible that that could be part of it. See if you can switch to days. If not….don’t hang in there. You’re an RN, for chrissake. Go find your bliss, because I’m sure there’s an RN blissy job for you. Probably one that’ll pay you well for working during the sunlight hours, too. You loved nursing once, for good reasons. Because there are good reasons to love it. Bump your salary for your good experience. Too many RNs don’t get that, stay in one spot to “finish their year” or “wait until they’re vested” or some other reason. Why?
Take your time. Clear your head. You’ll find it.
/jo
Hey Sean,
You have been so inspiring to a lot of people. I can see you’re going through a rough time, I can’t imagine the pressure you’re under. I hope things get better.
I’m rooting for you!
Elaine
Hey Sean
Good to hear you’re still alive! As the saying goes, keep your head up. You’re doing the right things (it sound like) for your patients, the other nurses be damned. It sounds like the folks you work with are a bunch of burned out jaded old hacks who need to re-evaluate their choices in career, but that’s just me.
Never lose the calm. We always need a rock of calmness when a situation goes to hell. Same goes for professionalism. I’d rather have a calm professional at my side when things go to sh!t than a bitchy hysterical know-it-all.
Best of luck, there’s many of us pulling for you out here in the blogosphere!
Hi Sean,
I’ve loved reading your blog and was so glad to see that you’ve posted again.
I’m going to be a senior nursing student and just finished an ICU internship. I’ve never commented on a blog today but this post moved me…
you’re a good nurse, that’s apparent. I think your gut is right. Your ability to stay calm is a wonderful attribute- it can only help you to think clearer, communicate better with the rest of your team, and lessen your patient’s anxiety…
It sounds to me like you’re just in a bad environment- those nurses you work with are burnt out and cynical, and they are the ones who need to change, not you!
your passion about nursing and learning is an inspiration. you’ve got what it takes.
Sean:
Great to see you back! I was wondering what was going on…
Thanks Strong One and Jo for those great words of advice. I’m entering my second year as an RN and even though I’m in the fitness program (what we jokingly call spinal cord rehab–due to all the twisting, pulling, lifting and running we do) and physically at my best weight in years, I sometimes want to take off running…literally out the door screaming.
I’m still working on my stress reduction skills, so that makes the days and evenings more manageable. I still miss some of the things about the office job I left to become a nurse two years ago, but not the weekend and holiday system updates that come with being in the computer business (not just nurses work weekends and holidays!).
I look at it this way…I have RN after my name. I have a couple of short-term goals. I always keep my eyes on the horizon to see what might be coming ahead. I know I will not be on the floor 30 years. I have a plan A and a plan B. I am going somewhere and I’m the one driving. That really helps.
Keep on driving, Sean. New places are all over for you to see! Don’t miss them!
Dark Place= Darklands
Like walking around in a bad neighborhood. Even better when you live in a bad neighborhood because you learn to love it cuz it’s your home. Sean, you know you’ll come out stronger and more wise, more effecient, more effective, experienced. Nursing is inherently fucked. If we can figure out how to exist in that fuckedupness (a true challenge) than life will be so much easier. And I think calmness, resisting the shit talking and bitchery is contagious and we will elevate nursing to a more professional level. You’ve really got to be zen about this shit or you’re gonna sink. Which you won’t. Cuz you are zen.
Normally posting lyrics to songs is exceptionally cheezy and adolescent but fuck it, sometimes it helps. I’m posting lyrics because when I’m on the floor they float around in my head and keep me even. Some songs help. Jesus and Mary Chain.
I’m going to the darklands
to talk in rhyme
with my chaotic soul
as sure as life means nothing
and all things end in nothing
and heaven i think
is too close to hell
i want to move i want to go
i want to go
oh something won’t let me
go to the place
where the darklands are
and i awake from dreams
to a scary world of screams
and heaven i think
is too close to hell
i want to move i want to go
i want to go
take me to the dark
oh god I get down on my knees
and i feel like i could die
by the river of disease
and i feel that i’m dying
and i’m dying
i’m down on my knees
oh i’m down
i want to go i want to stay
i want to stay
Just wait until the day when all hell breaks loose and you will be the one the docs come to because you will be calm. I can’t understand those who panic in the ICU, don’t go work there! In all the time I spent there I never found a nurse who panicked.
Don’t let the B~*”*£&! get you down! They are the idiots and you will rise above them.
i consider staying calm in a crisis a hallmark of a good ICU nurse. i worry about people who panic, usually they’re the newbies. **hugs**
Sean -
Thanks for the post. I’m just transitioning to the ICU after stints in PACU, rural health care and what we affectionately call “slow stream rehab” here in the Great White North. Upon first reflection, your post might have made go on that interview with a paediatric hospital I’m about to pass up. Instead, given it sounds as if we share some similar traits, I will forge ahead and see what I come out looking like on the other side.
Thanks very much for taking the time to share. I hope it gets better for you, one way or the other.
Cheers -
Matt
I felt compelled to comment because although I am a new grad and you are not, I feel the EXACT SAME WAY every day. Some days are better than others and I can’t imagine doing anything else, but most of the time I feel exactly how you described. Thank you for putting into words what I have been trying to express. Good luck with everything.
I came here by way of “Adventures in Juggling”. First, right of the bat, I want to say thank you. I don’t know if you hear it enough or ever from patients and their families, but I will say it now. Last month I nearly lost my 8 yr. old son to anaphylaxsis who had to be air-lifted and was in the PICU. I know how hard those nurses worked and they were patient with my when I asked a million questions and they always kept me informed. I know it will do NO ONE any good to get snippy or rude with those that are trying to help the patient. The nurse were fantastic and took fantastic care of my son the 3 days he was in there. I always make a point to be polite and thank them, no matter who the nurse or what part of the hospital my son is in. (He’s been hospitalized many times for severe asthma). God put you there for a reason. You’ll figure it out if it’s right for you soon enough. Good luck to you.
Oh man Sean, I was checking your blog thinking, “I wonder if something is wrong?” then something would filter through on facebook or somewhere and I wouldn’t think of it again. I’m so sorry this has been a tough summer* my friend.
I think some of the toughest things about being good at what you do (and you are as I know both from this blog and otherwise) is when things aren’t going well. Usually it’s good and you cruise along all happy to be learning… then bam, suddenly calm and compassion is wrong all of a sudden?! I want to meet that/those nurse(s) and tell him/her/them a few choice things about how those are some of your best qualities. Honestly, what a stupid criticism. And that your collegiality is seen as a detriment to your advocating for your patients is ridiculous.
Anyways, I’m not telling you anything you don’t already know, but I do understand how critique (both justified/constructive and the stupid) can build up and wear you down. So can too much novelty at once, you need to cruise on what you know for a while and really know it. I also know that you are smart enough to take on board the good points and leave behind the ridiculous.
Is there a way you can break your day down even further to “I know exactly what I have to do for the next 5 minutes”** I’ll bet you do know what you are doing often, you’re just so bombarded with newness that you can’t see the trees for the forest.
All the best, Jen
*and I’ll bet the weather has something to do with it — seriously! Especially as nice a summer as I hear you all are having. Like Seasonal Affective Disorder (SAD) works in opposite for night shift workers and they get bummed in the summer… Could be on to something, wanna co-author a paper?
**(throw in a Stuart Smiley positivity statement too: “…and I’m good enough and smart enough and gosh darnit patients/doctors LIKE me!”)
Sean-
I can not believe I found this! I have the exact same feeling. It was weird. I was totally fine and into my job and than all of a sudden I hated my job and did not even want go to work. I was miserable. This lasted for a few months! I thought I was done and then just as quickly it went away. I think it will pass!
I’m feel you man
Time to try a different hospital. Ive worked all over the country, and some are definitely better than others. Sounds like yours is not open to having newer staff, and stuck in a rut of complaining. Try a different one if you can. Its worth the move to save yourself.
I feel the exact same way now. I’m an LVN and got accepted into an RN program. I don’t even know if I want to do this anymore! I’m looking at other avenues, Nuclear Medicine and Radiation Therapy. Just not sure my heart is in it anymore.
People say it’s so rewarding to be a nurse. I’ve yet to feel ‘rewarded’. I just come home worn out and DREAD going back. Ugh.
Dave