Just yesterday, I went to the office of the visiting nurse/hospice agency that I work for as a per diem nurse, and I tendered my resignation.
With my public health nurse position consuming 30 hours of every week (and a large percentage of my cerebellar real estate), my per diem hospice position was so much background noise cluttering my mind and causing me professional anxiety. All of us who work in health care are acutely aware that maintaining a position at any facility or agency means that one has to attend trainings, keep up with changes in policies and procedures, and keep one's finger on the pulse (pardon the pun) of the organization. As a per diem nurse, this can become quite a challenge when one's life gets in the way of staying abreast.
In January of 2008, I quit my full-time case management position and entered a period of self-employment, working a number of part-time and per diem positions, consulting gigs, and online writing assignments. That professional juggling act was exciting and novel, but now that I've settled into a more or less full-time position in a demanding municipal job, keeping up with other agencies' changes and demands becomes less and less attractive and more of an emotional and mental drain.
Giving up my position of per diem hospice nurse is a mixed decision, and one that I make quite consciously. Hospice nursing is close to my heart, and is an area to which I would like to return in the future. However, as a per diem who only takes a shift from time to time, I find that making hospice visits causes me considerable anxiety and concern. When one works with the dying on a regular basis, knowing what to say and what to do becomes second nature. The symptom management, the medications, the little tricks and trade secrets all live in a Rolodex in the nurse's brain and are easily retrieved and shared. For me, those tips and secrets are not second nature, and I am loathe to deliver care that does not conform to a standard of excellence to which I hold myself wherever I work (and I recognize that this is also not in the best interest of the patients and families that I would serve).
As a public health nurse, I am no longer delivering direct care, and I do indeed sometimes miss the direct patient contact and assessment that goes hand in hand with that form of nursing. Less than a few years ago, I was a Nurse Care Manager, overseeing the coordination and care of more than 80 chronically ill patients living on Medicaid in the inner city. That work was a part of my personal and professional identity, and was also great fodder for my writing here on Digital Doorway. But my life has changed, and I have entered a period where nursing has taken on a different veneer, and instead of providing nursing care to a group of individuals, I provide the attention of a nurse to an entire municipality, its residents and its employees.
Letting go of my direct care positions is done with mixed emotions and a great sigh of relief. I have no doubt that my nursing career will take many twists and turns in the future, but for now, I am shedding what feels too burdensome, knowing that one closed door only makes room for ten more doors to open.