I have absolutely no answers or solutions for you re: sleep. I haven't sleep well since I got off pristiq in mid Dec 2009. My work is stressful and now that I don't have the SNRI to help. I am right back to where I started in Oct 2008 when I first started taking them after beginning a new job on a busy med/surg nursing unit. I figured I had developed good coping skills, which were helping me to control the anxiety.

I got off the drug b/c I wanted to and with the support of the meds mngt psychiatrist, who had been prescribing them. Before I restarted taking SNRIs, I had been off antidepressants since Oct 2007 as a result of successful psychodynamic therapy for a 15 months. I have had GAD since I was 11 yr. old. Every time I think about my job when I am at home, I get this automatic fight or flight response. All I have to do is think "work". Nothing makes me more anxious than thoughts of work. Did I do the best that I could despite the challenges against doing just that? Nursing mess up all the time there b/c of the intensity of the unit, patients and over all team leader responsibilities. There is simply too much stuff that I am responsible for, yet most of it is out of the nurse's control b/c other parties have to do there part. I am supposed to have a grip on everything from the moment a patient arrives to the unit to the moment the leave our unit. It is the nurses' job to see that all the physician orders are carried out, even if through a third party entity like radiology, pharmacy or laboratory depts. If a ball gets dropped the RN TAKEs most of the heat. The RN is responsible for ensuring that the unit clerks put all the orders in correctly even though that should be a job requirement for them. If we tell a nurse assistant to do something and they don't do it. The RN is partially responsible b/c we didn't motivate or communicate our instructions well enough. Doctors want us to know what ever consulting physician has done for their patient even though we often don't speak or see the consultants. We are expected at some point to have read the patient's chart, in our spare time on the unit I guess and note discrepancies. If a doctor fails to see his patient, we are expected to call them and find out why. If a doctor fails to chart on a certain mandated form, the nurse is held accountable for not getting the doctor to do it.

I think my stress is justified giving my job requirements. I must deal directly with the patients, who are oftentimes needy and demanding including their families as well as very sick. I am expected to do the impossible in a very limited time frame. Also I am expected to chart everything that I've done or that the pt needed done in one of 5 different places for just that. Crap, this job is a failure waiting to happen. Heaven forbid if your patient has an emergent or urgent situatiion, which they almost always do that takes up an abudance of your time and energy. And no other patient cares that you were busy; they are upset that you weren't with them when they needed you. I usually have 4-7 patients per 8 hr shift. Did I mention that I have no choice in which patient's I get assigned or how many I will be responsible on a given day. We are usually not staffed adequately, yet the admission and transfers to our unit still occur. I am just expected to gladly take on the new patient even if I am drowning in the responsibilities of the current patient load.

I need a career change or a work environment that recognizes that a nurse simply cannot do it all during a single 8 hr shift. It's too much responsibility. You can maybe a few things okay but not everything will be high quality. It's mostly patchy or scetchy at best. Where is the job satisfaction in that?

Thanks for letting me vent.