Case Study #6 Renee C.: Thriving as a Nurse Practitioner
Hey ya’ll, I want you to meet Renee!
She is a CIVCU Nurse Practitioner working in Nashville, Tennessee. She and I met through the blogging world YEARS ago and have been online friends ever since. When I started looking at travel nursing, she was one of the people who helped answer all my questions. I’ve loved watching her develop and grow as a nurse and I admire her ability to manage her work/life balance!
Fun fact, Renee has actually been honored with a DAISY award! You can read her nomination here! There’s a sweet story about Renee talking with an elderly patient who told her the only thing she wanted was to be home, holding her husbands hand, and watching the sunset. The patient’s husband couldn’t be there, but the next day, Renee arranged to help the patient get outside in a wheelchair and watch the setting sun from the helipad. This gives me all the feels! It feels like the time I watched the movie “Up” for the first time and bawled in the first 5 minutes of the movie.
1. Please tell me about yourself and your nursing career up to this point.
Hi all! I’m Renee and I currently am a Nurse Practitioner in a CVICU. I first started my nursing career in 2008 after completing my BSN at The University of Mississippi Medical Center. I started in a 10 bed CVICU as a new graduate and it was incredibly overwhelming. I stayed in that role for about 2.5 years until I felt like I needed a change which I will elaborate on a little later. That change took me to an EP Device Clinic for about 2 years and then I felt like I missed the aspect of bedside nursing again. I also knew travel nursing was something I wanted to experience so I decided to take a leap of faith and pursued travel nursing. I moved to California without knowing a single person and it was great! I ended up not traveling much but stayed at the same hospital for 3 assignments which was around a year. I felt like I needed to be closer to home and also wanted to go back to school so I moved back to MS and went back to that same CVICU (now 20 beds) that I first started my career in but this time on nightshift. I eventually switched to dayshift and went back to school and obtained my MSN as an Adult-Gerontology Acute Care Nurse Practitioner at the University of South Alabama. After finishing my degree in December 2016, I finally found a job in Nashville, TN working nightshift in a 27 bed CVICU. In the immediate future I see myself continuing to grow into the NP role in my current CVICU. I work with amazing, knowledgeable NPs, PAs, and MDs that teach me new things every shift at work. I’m not sure I see myself in ICU for the long haul but right now I can’t imagine not having the acuity and challenges to deal with while also continuing to educate myself from a provider standpoint.
2. Burnout is defined as "exhaustion of physical or emotional strength or motivation usually a result of prolonged stress or frustration." Have you ever felt burned out? How did it develop and how did you handle (or not handle) it? What would you have done differently?
I have definitely felt burnout before as I briefly mentioned above. Being a new nurse and starting in a CVICU definitely takes a toll on you both physically and mentally. After about two years I really felt like I had become slightly bitter from a nursing standpoint. I wasn’t happy at work and dreaded going in most days. I had an amazing crew of people working by my side during my beginning years in nursing who literally never let me drown and always put teamwork first. I have honestly never seen that kind of teamwork since. Even with amazing coworkers and decent staffing ratios burnout still happens. For me, I felt like it developed simply from the non-stop acuity and frequency of dealing with death. I had lost my compassion for my patients and their families and I personally felt like if I didn’t make a change for myself my patient care wouldn’t be the quality it should be.
I applied for a Pediatric Intensive Care position initially. And thankfully I didn’t get that job. I was insane to think that going from an adult critical care setting to a pediatric critical care setting would have helped me. It was great interview practice and I was much more prepared for the next job I applied for and was lucky enough to be offered. The EP Device Clinic was a perfect breath of fresh air from the acuity of a critical care ICU. I was still challenged by learning the different ins and outs of permanent pacemakers and internal cardiac defibrillators but I wasn’t dealing with real-time life or death decisions. And after a few years in that role it refreshed me enough to where I wanted to return to ICU nursing.
3. What do you do on your days off to push through it and get ready to bounce back for the next shift?
After difficult work weeks for me I usually try to recharge by spending time with friends outside of work. I enjoy trying new restaurants and just taking time to chat with friends about life. I also try to incorporate an exercise routine into those days off. Working nightshift that isn’t always the easiest but definitely important. I also try to travel (for fun) still when I can.
4. If you could change one thing about nursing to address burnout, it would be:
I think a lot burnout happens from inadequate staffing ratios combined with not enough teamwork. I have worked in two very different settings as far as staffing assignments go. In Mississippi, the rules for nurse assignments aren’t very strict at all compared to California. These are probably two extremes and not every hospital in MS is the same with assignments, but in California they have nursing unions and the expectations for hospitals are standardized across the state. So devices such as CRRT or IABPs are always 1:1 ratios in California. In MS there were no set ratios regarding devices. Of course our charge nurses would do their best to equal assignments based on acuity but the attention it takes to pay attention and make sure you are charting all your numbers for both devices could be exhausting in itself. And working in a critical care environment charting is unfortunately minimal on the possibility of exhausting tasks. The possibility for catastrophe of some kind to present itself and take a large portion of your time is always there. So I think being an advocate in your hospital and community regarding adequate staffing, great teamwork, and having the ability for debriefings with peers to talk about difficult situations are incredibly important. Just being able to vent with another medical professional after a trying shift is incredibly comforting.
5. How long did it take you to feel "comfortable" in each new role you've taken on? Any advice to nurses who are experiencing the stress of starting something new?
I think I am probably not the norm when it comes to this question. I think in the ICU as brand new RN it took me at least 6 months to begin to feel like I was going to be ok in that role. As a travel nurse I had probably 4-5 years of nursing experience so I caught on to that a bit easier. The most difficult part of travel nursing for me was learning their systems quickly and learning where to find all the equipment/supplies you need. Each place you travel to will not keep something as simple as tape in the same spot.
And for the most recent role of NP, it has taken me almost a full year to feel comfortable with my role. I had a lot of change at one time with this one but from the research I saw while I was in school I think around one year to feel adequate with the role transition was average. With the transition to NP I changed hospitals, computer systems, all the coworkers were not my years long friends/coworkers, and then combine that with a new role as provider made it a rocky transition. For the first several months while in orientation I would go home after work and many nights would have a cry session and wonder what in the world I had done. Once I was on my own and didn’t have a preceptor with me my confidence definitely started to improve. Even after almost 10 years of cardiac nursing experience it was a huge adjustment to go from being a very capable and competent/confident bedside nurse to a new NP who constantly questioned her own decisions. Even some of the most simple decisions 6 months ago didn’t come nearly as easily for me as they do now after almost 1 year in the role. After more time as an NP I can now say I am so thankful I made this huge transition and feel like I’m exactly where I should be!
6. I keep my spark for nursing alive by:
Taking the time to celebrate the small victories! It is so rewarding to watch people who were literally dying improve and start to look better. In the ICU we often send people out and don’t necessarily get the satisfaction of seeing them make it out the door and home so when I see patients who come back in normal clothes and looking amazing it reminds me of the reason I show up to work daily!