I'm going to preface this entire blog by saying that I'm at a very good place in my career. I enjoy what I do, like my coworkers, feel generally well supported by our immediate supervisors, and am well compensated for my time. It was a long road to this place, and there were a lot of pitfalls along the way. I guess, in sharing this, I'm hoping that the takeaway is this: Do not stay in a toxic environment, and there is life after burnout.
I've been reflecting on my nursing career recently. 10 years ago, I started my Associate's Degree program. 10 years later, in the present day, I'm starting my Psych NP clinicals. I've traveled a lot of ground in this last decade, personally, professionally, and academically, so here goes....
Let's start with my first job. This part of my cautionary tale applies to the brand new baby nurses. I started my career in critical care. What should have been a great learning experience occurred in one of the most toxic environments I have ever survived...anywhere. My first preceptor, as a new grad. Constantly rolled her eyes at me, talked down to me, reprimanded me in front of patients and their families, and made me feel stupid for asking questions. One day, she mentioned that she had a headache from "too much wine" the night before. That same day, she hid out, nursing her hangover, and decided to tell my charge nurse that I wasn't a good fit for her. This left me, as a brand new nurse, on a unit where I knew almost no one, without a mentor. It also put a target on my back, because this was an environment where this nasty woman had a lot of clout. If I was on the outs with her, I was on the outs with almost everyone.
Fortunately, there were some really good people who I worked with that circled the wagons, and agreed to help me out. I learned a lot from these ladies, and really owe the foundation of my skills to them and them alone. My previous preceptor? Let's just call her, #1. She did everything she could to make sure that the doctors, other nurses, respiratory therapists, nurses aides, radiology techs...pretty much everyone who would listen, think of me as the village idiot. What happens when you're made to feel like a walking piece of shit? Well, you certainly don't learn very easily...and you don't flourish.
My first day off of my preceptorship. Literally my very first day on my own, I had a patient with an order for a PCA pump (that's patient controlled analgesia). This is not a common occurrence in critical care because most of our patients were too incapacitated to control their own pain medication dosing. Due to the nature of this type of pump, and the risks involved with giving too much IV narcotic medication, setting up this pump required 2 nurses to look at the settings and sign off on it. I asked for help, and no one really knew how to do the initial set up. Our educator happened to be on the unit, so the charge nurse had her help me set it up and act as my co-sign on the dosing. The educator really struggled with helping me set up this pump, and my being new (and the village idiot) I didn't really feel comfortable speaking out. The charge nurse sent 1's BFF...we'll call her #2...into the room to double-check the dosing. I'm glad she did, because the educator had set it up wrong! 2 came back, told me that it was set up wrong, we corrected it and that was the last I heard of it, until it was time for my annual review.
At my review, I was told that I would only be getting a 2% raise, because I had a med error on my record. A med error? I had never been told about a med error! My charge nurse brought up the error in the set up of the PCA. I objected, stating that the educator (let's call her 3) had helped me set it up. My charge nurse responded, "We asked 3 about it, and she denied setting anything up with you." When I objected to her obvious lie, the charge nurse just shrugged and said that she knew...and that there was nothing she could do about it. So, 2 had written me up and just didn't say anything. The charge nurse that day didn't say anything...and 6 months later I first hear about it, as the excuse for giving me a shitty raise. Between the paltry raise and the increase in my benefit cost that year, I was making less than I did the year prior. The money was so shitty, that with the cost of living in Orange County, I had to have a part time per diem gig as a surgical nurse. Most of the nurses I worked with had part time jobs, which is insane if you actually think about how intense it is to be a full time critical care nurse. I started looking for other jobs...
Now, the abuse suffered at the hands of 1 and 2 was ongoing. I overheard them conspiring to stay away from helping me with anything right after morning report one day. They were talking about how they were going to leave me out to dry and laughing about it. I knew that they wanted me to hear this. In the ICU, it really needs to be a team environment. One nurse can't change a soiled patient, or reposition them every 2 hours so they don't get bed sores, or run a code by themselves. I started scheduling myself whenever they weren't working whenever possible. Here's how it worked with healthy co-workers: we would have "turning parties" where we would all team up to help reposition one another's patients. We would discuss the patients that were high risk for coding, so that we all sort of kept one eye on that patient for monitor changes. We would laugh together, offer to break one another. This is how it worked when 1 and 2 weren't on the same schedule as I was. This is how it should have worked all the time. I didn't sleep the nights before I had to work with the unholy duo. I cried on my way to work on those days.
The final straw wasn't the shitty pay, or the bullies, it was a back injury. I had a confused patient trying to get out of bed. I ran into his room, verbally redirected him, and casually picked up his legs to help him lay back down in bed. That's when I felt the pop in my lower back, and searing hot pain shot through my entire left leg just before it went numb. I told my charge nurse, who asked 1 to take my patients from me so I could go to the ER. 1 was working rapid response that day, which the ICU nurses liked doing because you got called to the rapid responses on the other units and didn't have to have a patient assignment. The RRT nurses sometimes got pulled into the unit if there were more admits than nurses, or, as was in this case, if one of the nurses had to leave. 1 just disappeared after she was asked to take over my patients. She disappeared for 45 minutes, while I struggled to take care of my patients in the worst pain I've ever experienced. The charge nurse asked why I was still there almost an hour after my injury. I told her because 1 was nowhere to be found. She tracked 1 down, and 1 heaved sighs, interrupted me, and rolled her eyes through my giving her report. I still have residual pain from this injury, 7 years later.
Right around this time, I was offered another position at a different hospital. It was almost twice my salary at my first job. **Pause for a second here...same job, twice the pay. Both healthcare systems are very successful, both COULD afford to pay their nurses what the second job offered, only the first hospital system simple chooses not to, because they consider the "pride" in working there to be part of your benefits package.**
I was scared to leave, because I was not confident in my skills at all (clearly I was capable, having been offered a job where it is actually really hard to get hired), and I had a few friends that I loved working with. I heard 1 and 2 conspiring to leave me hanging on the day I was either going to put in my 2 weeks notice, or let the new hospital know I was declining the offer. That cemented my decision, and I put in my 2 weeks notice that day. On my very last day, one of the nurses that I had really come to love was charge nurse. She put me on the telemetry desk, since one of the tele techs was out sick. It was a nice gesture, and guaranteed a relaxed day. 2 looked at the other tele tech and said to him, "If you need any help, let me know," she looked right at me and back at him and said, "because you're going to need it." I fired off an email to the department director, and explained the bullying I had experienced at the hands of 1 and 2, and that this was the real reason for my leaving. She showed up, within minutes of my email, and pulled 2 aside. I have no idea what she said to her, but she wouldn't even look at me for the rest of my shift.
I moved on to much better things in my career. The lesson in this story is this: If you're in a toxic environment, leave. End of story. Find something else and leave. If you have your RN license, and you have a least a year of experience, you're marketable almost anywhere. Too many people stay in a toxic environment because they are afraid of change. I was so burned out in my first job, that I looked at the gardners outside and considered making a career change to landscaping. "They work outside...get good exercise..." I can hear myself day dreaming.
I moved on from this job into different hospital systems, different units and different specialties. ALL of those jobs had more positives than negatives. The moves that I made after leaving my first job were calculated decisions that I made to advance my career in various ways. None of those moves were to escape an unbearable situation. Writing this was cathartic for me, because I have carried this trauma and embarrassment with me for years. It feels good to get it out there.
I've become confident and capable through wonderful managers and coworkers who helped me to be the best nurse I could possibly be. I owe all the wonderful things in my career to those people on the way (as well as the nurses who did try to shield me from the bullies in my first job). We need good nurses and can't afford to bully out our new grads or new hires. Those of you who know me are probably surprised that I was so vulnerable to bullies. I was in a position where I was just starting my career, after spending years trying to get to that starting point. I was so terrified of failure that my defenses were down. I had devoted my life to becoming a registered nurse, and literally had no back up plan if something went wrong.
Thanks for listening...hopefully this blog will inspire you to move away from a toxic unit, or know that you aren't alone if you've been a victim of bullying. For any new nurses reading this, know that you deserve better than to be eaten alive. It's not like that everywhere, I promise!
