r/psychnursing • u/PleasantDirection751 • 9d ago
Feeling burn out after 5 years, starting therapy but I don’t know what to work on in therapy?
A bit of a long one, sorry. I’m really looking for advice about my situation
I’m not a nurse, I’m a tech in the ED. Been doing night shift 3x12s in a row every week for 5 years straight. Because it’s ED, I work with every type of psych patient (bedridden geriatric, 7 year old autistic behavioral issues, teenagers with depression and panic attacks, alcohol withdrawal meth withdrawal of all ages, just the whole rainbow spectrum of issues). I’m supposed to only be working 1:1 but that rarely happens. I’m often 2:1 even with high risk suicidal pt’s. I’m really good at de-escalation and keeping pt’s relatively calm during my shift. I don’t take shit personally. I’m the person my manager has train new people because of my hands on skills and experience.
Workplace violence has just been getting worse and worse though. Coworkers getting broken legs, fractured jaws, chocked and head locked regularly. I’ve had my fair share of physical/sexual/verbal violence as well. I’ve decided to go down to 2x12s because of this, and because I’m just now feeling the emotional burnout of this line of work. Sleep issues are catching up to me now because of night shift too lol
My loved ones are concerned for my safety and are very aware of the emotional burden the job takes. They’re super understanding and have been encouraging me to go to part time so I can rest.
I’ve been wanting to go into psych nursing so I’m currently finishing my pre-requisites. I have a huge passion for the psych population. I just care. I’ve had countless pt’s thank me personally because I’m considerate and I actually treat them like people and provide them a sense of safety in a really scary and hectic environment.
I do my best to have extremely firm boundaries on the job, especially with folks who are extremely violent and abusive towards staff.
I do recognize I sometimes have an unhealthy mindset of getting my self worth out of being “needed”. Definitely comes from my childhood sexual assault and a long term ex relationship where I was severely abused and in order to avoid abuse and keep myself safe, I had to take on a caregiver role. I won’t deny that it feels good to successfully de-escalate someone or help someone through a panic attack or psychosis. That skill I have and feel good feeling is what I used as a survival mechanism to survive my past abuse
All this is to say: the burn out is affecting me in a very particular way: I have very little patience for when my loved ones need support from me. I have a great support system and I’m no longer taken advantage of by others, of course. Sometimes people just have bad days and need a shoulder to cry or or just some kind words or just want to vent about small annoyances.
I just want to get away when I feel like people in my personal life “need” me. I just shut down. I feel that obligation to have to fix them and that makes me feel scared. I start to think “if I’m not careful with my words or if I don’t help them perfectly, what if they scream at me what if they hit me, why can’t they just turn off their emotions and suck it up like I can? I’m so sick and tired of helping people” Obviously my loved ones won’t hurt me. But my patients sure do so that thought is just sorta always in the back of my head with my loved ones.
It’s weird because I don’t feel like this at work. I just sorta go into work mode. I do my job, it doesn’t bother me, then I clock out. But as soon as it’s a personal relationship outside of work? I just want to get away and i feel scared. It’s sorta similar to how when I’m in emergency situations I’m the calmest person in the room. But when I’m in a non emergency situation and it’s just everyday small stressors, those feel like emergencies and I sometimes shut down
I’m starting therapy but I just. I don’t know what to even do or talk about? What are the steps I need to take to help mitigate this burn out? I’m just at a complete loss. I want to be able to have connections with people but I’m just so scared of connecting and I want to be left the hell alone at the same time.
And it’s like I’ve put so much energy, for years, to take care of people. Help them feel safe, talk them through panic attacks and psychosis, hold people down from violently thrashing around and ripping out IVs, feeding people bathing people, comforting, listening, compassion…. Everything. I can do it for other people but I DONT know how to do it for myself. And I do it so much for other people that I’m just tired and I don’t wanna do it for myself.
t’s exhausting. It’d really appreciate any advice
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u/No_Idea_9206 9d ago
Here to say you’re not alone. It’s normal AF. Proud of you for choosing to do the work. Nights + high-stress/volatile work environment is no joke. Therapy taught me how to choose me and others too. It can help shed light on some inner workings and provide a safe release from the pain. Vicarious trauma is real. Big trauma and little trauma is also very real in this field. Choose you. Keep going in your own direction. It’s okay if it changes. It’s okay to take time away. It’s okay to not know.
Therapy, taking a break from the ER, and ketamine assisted psychotherapy helped me recover from pretty severe burnout. I’m more compassionate now than ever, but the main difference is that I can offer myself grace and kindness first then pour the rest into others.
It sounds to me like you are an asset to this field. Take care of yourself so you can take care of others. You got this. 🫶
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u/PoluxFlux 8d ago
Go to your first therapy session and say exactly what you just said here:
“I want to be able to have connections with people but I'm just so scared of connecting and I want to be left the hell alone at the same time.”
Let the therapist take it from there. Don’t worry about having a whole speech for the therapy session; it will flow organically. You communicate with a lot of detail, so it’ll most likely go well.
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u/DashMcGee 8d ago
Psych has a way of frazzling your nerves. I don't have any advice for you, but know that you are not alone. You are not weak for having these thoughts and feelings. You can just be open with your therapist and tell them what you said here - even show it to them. I kind of get the vibe that you think you are supposed to be stronger than you are and are trying to confess your perceived weakness in the anonymity of Reddit. If a patient shared this with you, your first response would be to reassure them that they are not weak - that they are human, and humans have frailties, and hiding from them does no good. You are not weak; it takes strength and insight to reveal what you revealed here. Run with that.
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u/HollywoodGibby_ 5d ago
Honestly you already identified a lot of what you should work on in therapy. It sounds like you learned pretty young that being useful and managing other people’s emotions = being safe, and then ended up in a job where that exact skill gets reinforced constantly.
I’d bring up that connection specifically. Especially the part where you can handle someone actively psychotic at work but a loved one having a bad day makes you want to run.
Also, going part time sounds like a good move. You can genuinely love psych and be great at your job while also realizing that being exposed to other people’s crises 36 hours a week is costing you something.
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u/Charming-Tune-6914 9d ago
I wonder if a general sedative can be given to all admitted to your facility?
"we don't know how that got in the water.
I am guessing the therapist will identify appropriate goals for you based on your conversation, kinda their job? Can you do weighted strength training to help defend yourself if/when necessary?
Have you studied the employment policies concerning self defense and identified areas of significance?
I hear some people dislike being pinched which can only ever result in superficial pain, not advocating anything.
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u/PleasantDirection751 9d ago
We do give sedatives when necessary and we also have restraints, restraint chairs, and seclusion rooms. But that doesn’t prevent violence from happening. Those steps only happen after violence has already occurred
We do have a single mandated self defense training each year. But it really doesn’t do shit. If a patient really wants to knock my lights out or attack me, it’s gonna happen. The only thing I can actually do is scream for help and walk/run away at that point
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u/perderla 9d ago
Compassion fatigue, showing up every day to a violent environment, night shift, your trauma history and current confusion... Maybe take a year's break working in a lower intensity environment while you figure out what to do?
If you can't get yourself to change jobs for the near future, continued self-defense and strength training, absolutely.